CTICasesCoronary Sinus Ostial Atresia with Anomalous Venous Drainage
Imaging findings
CT incidentally on a cancer follow-up shows an unusual vein that is not in the typical location of a persistent left SVC but is contiguous with the cardiac veins, resembling a middle cardiac vein draining into the great cardiac vein and ascending to connect with the left brachiocephalic vein. There is no connection between the coronary sinus and the right atrium. Contrast density indicates cephalad flow from the coronary sinus, which is bright, into the darker brachiocephalic vein.
Key takeaways
Coronary sinus ostial atresia diverts coronary venous return through an anomalous connection, here draining cephalad into the left brachiocephalic vein rather than into the right atrium. Recognizing this uncommon anomaly is important because the vein provides the sole coronary venous outflow, and inadvertent ligation could cause venous myocardial infarction. Contrast timing and density help establish the direction of flow.
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