Coronary Sinus Drainage Anomaly
Imaging findings
CT chest in a 27-year-old with congenital heart disease shows osteal atresia of the coronary sinus. Instead of draining into the right atrium, the coronary sinus drains anomalously into the left atrium, creating a right-to-left shunt.
Key takeaways
Coronary sinus osteal atresia is a rare anomaly where the coronary sinus fails to open into the right atrium. Venous drainage is typically redirected through a persistent left SVC or, less commonly, directly into the left atrium, creating a physiological right-to-left shunt.
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