CTICasesCor Triatriatum Sinister with Levoatrial Cardinal Vein
Imaging findings
Chest radiograph in a 27-year-old woman demonstrates a classic snowman sign, typically associated with supracardiac total anomalous pulmonary venous return. Cardiac MRI and echocardiography demonstrate a Cor Triatriatum Sinister with a restrictive intra-atrial membrane dividing the left atrium. A persistent vertical vein, representing a levoatrial cardinal vein, arises from the accessory left atrial chamber and drains retrogradely into the left brachiocephalic vein, resulting in a severe left-to-right shunt.
Key takeaways
Cor triatriatum is a rare congenital cardiac anomaly where a membrane divides the left atrium (sinister) or right atrium (dexter) into two chambers. A levoatrial cardinal vein is a persistent embryologic venous connection that allows decompression of the left atrium into the systemic venous system in the setting of left-sided obstruction. In this adult, the combination of Cor Triatriatum and the shunting vertical vein led to right-sided volume overload and a late presentation mimicking TAPVR.
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