Chiari Network – Just an Innocent Bystander or Can Have Serious Impact on Clinical Outcomes
American Journal of Internal Medicine
Volume 7, Issue 2, March 2019, Pages: 33-35
Received: Mar. 4, 2019;
Accepted: May 14, 2019;
Published: May 30, 2019
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Anum Asif, Department of Medicine, University of Pittsburgh Presbyterian Hospital, Pittsburgh, USA
Nauman Farooq, Department of Medicine, University of Pittsburgh Presbyterian Hospital, Pittsburgh, USA
Tayebah Mumtaz, Department of Medicine, Geisinger Medical Center, Danville, USA
Chiari network, a remnant of sinus venosus is often incidentally diagnosed on routine echocardiograms. Chiari network occurs due to incomplete resorption of right valve of sinus venosus. It is often noticed as fenestrated membranous structure or reticular network like structure in the valve of inferior vena cava and coronary sinus. The structure was first described by Von Rokitansky in 1875 and gained its name after pathologist Hans Chiari in 1897 when he described the structure in 11 cadavers. There are inconsistencies in the exact prevalence of this structure and has been reported in literature from 2-13.6%. Most of this data is available from cadaveric or autopsied hearts. These structures are usually considered as benign congenital malformations but literature has reported various cases which have resulted in medical complications including endocarditis, thromboembolism or procedural difficulties. These structures can also mimic right atrial pathologies or thrombus creating a diagnostic challenge. It is important that clinicians are aware of these since misdiagnosis can have significant effect on clinical course and outcomes of the patients. The possibility of the presence of these congenital remnants should be kept in mind during clinical decision making. We present two clinical scenarios with incidental diagnosis of Chiari network and its effect on the clinical course of these patients.
Chiari Network – Just an Innocent Bystander or Can Have Serious Impact on Clinical Outcomes, American Journal of Internal Medicine.
Vol. 7, No. 2,
2019, pp. 33-35.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical anatomy of the atrial septum with reference to its developmental components. Anderson RH, Webb S, Brown NA. Clin Anat 12:362–37 (1999)
Schneider B, Hofmann T, Justen M. H, Meinertz T. Chiari's network: normal anatomic variant or risk factor for arterial embolic events? Journal of the American College of Cardiology. 1995;26(1):203–210. doi: 10.1016/0735-1097(95)00144
Bhatnagar KP, Nettleton GS, Campbell FR, Wagner CE, Kuwabara N, Muresian H. Chiari anomalies in the human right atrium. Clin Anat. 2006;19(6):510-6.
Chiari's Network: Normal Anatomic Variant or Risk Factor for Arterial Embolic Events? Brike Schneider MD, Thomas Hoffman MD, Maria H. Justen MD, Thomas Meinertz MD. Handbook of Cerebrovascular Diseases Second Edition, Revised and Expanded (2005)
The Chiari Malformations. R. S. Tubbs, W. J. Oakes (eds), 5 DOI 10.1007/978-1-4614-6369-6_2, Springer Science + Business Media New York 2013
Echocardiographic appearance of the Chiari network: differentiation from right-heart pathology. Werner JA, Cheitlin MD, Gross BW, Speck SM, Ivey TD. Circulation 1981; 63:1104-1109.
Giant Chiari network mimics intracardiac tumor in a case of neurofibromatosis. Koz C, Yokusoglu M, Baysan O, Uzun M. Int J Cardiol 130:488–489 (2008)
Chiari’s network: normal anatomic variant or risk factor for arterial embolic events. Schneider B, Hofmann T, Justen MH, Meinertz T. J Am Coll Cardiol 26:203–210(1995)
Chiari network entrapment of thromboembolic: congenital inferior vena cava fil-ter. Goedde TA, Conetta D, Rumisek JD. Ann Thorac Surg 49:317–318(1990)
Catheter entrapment in a Chiari network involving an atrial septal defect. Goldschlager A, Goldschlager N, Brewster H, Kaplan J. Chest 62:345–346(1972)
Prajapat L, Ariyarajah V, Spodick DH. Abnormal atrial depolarization associated with Chiari network? Cardiology. 2007;108(3):214-6.
Schwimmer-okike N, Niebuhr J, Schramek GG, Frantz S, Kielstein H. The Presence of a Large Chiari Network in a Patient with Atrial Fibrillation and Stroke. Case Rep Cardiol. 2016;2016:4839315.
Pothineni K. P, Nanda N. C, Burri M. V, Singh A, Panwar S. R, Gandhari S. Live/real time three-dimensional transthoracic echocardiographic visualization of Chiari network. Echocardiography. 2007;24(9):995–997.
Altbach M. I, Squire S. W, Kudithipudi V, Castellano L, Sorrell V. L. Cardiac MRI is complementary to echocardiography in the assessment of cardiac masses. Echocardiography. 2007;24(3):286–300.