96 Visite/Pictorial Essay
Prominent Crista Terminalis in the Neonatal Period
Authors
A. Pérez-Muñuzuri, S. Fariña, A. Baña-Souto, O. López-Suárez, M. L. Couce-Pico
Affiliation
Pediatrics/Neonatology, Hospital Clínico Universitario, Santiago, Spain
The prominent crista terminalis (PCT) is an anatomical variant of the heart sometimes observed in older patients. We present a female newborn of a healthy mother with no relevant medical history. During pregnancy, a right intraatrial malformation was detected by ultrasound, establishing the suspected diagnosis of prominent Eustachian valve or tumour. At birth, echocardiogram showed an atrial septal aneurysm, a Chiari network inside the right atrium and an echogenic image located at the top and posterior surface of the right atrium ▶ Fig. 1, 2) of 6 mm, that not modified blood flow ( ● and did not change with time and was labeled as PCT. Normal Eustachian valve was checked ▶ Fig. 3). ( ● Crista terminalis is a normal fibromuscular ridge at the posterolateral region of the right atrium and has a close relationship with the sinus node (Salustri A et al. Prominent crista terminalis mimicking a right atrial mass: case report. Cardiovasc Ultrasound 2010; 8: 47). Occasionally, it
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1395664 Klin Padiatr 2015; 227: 96–97 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0300-8630 Correspondence Dr. Alejandro Pérez-Muñuzuri Pediatría Hospital Clínico Universitario Choupana s/nº Santiago Spain 15706 Tel.: + 34/981/950 162 Fax: + 34/981/950 292 [email protected] Pérez-Muñuzuri A et al. Prominent Crista Terminalis … Klin Padiatr 2015; 227: 96–97
can be prominent which can mimic other findings as a mass, thrombus (Gaudio C et al. Prominent crista terminalis mimicking a right atrial mixoma: cardiac magnetic resonance aspects. Eur Rev Med Pharmacol Sci 2004; 8: 165–168), or variants of normal structures as Chiari network or Thebesian and Eustachian valves (Akcay M et al. Prominent crista terminalis: An anatomic structure leading to atrial arrhythmias and mimicking right atrial mass. J Am Soc Echocardiogr 2007; 20: 197). Its diagnosis in adult patients can be performed by transesophageal echocardiography. However, the good transthoracic window in newborn babies could come close to a diagnosis by non-invasively echocardiogram. Although not frequently, it may be associated with other phenomena such as atrial septal aneurysm. These 2 structures can act as arrhythmogenic focus (Bolognesi M et al. A prominent crista terminalis associated with atrial septal aneurysm that mimics right atrial mass leading to arrhythmias: a case report. J Med Case Rep 2012; 6: 403) (Zhao QY et al. Fig. 1 2D echocardiogram showing an echogenic mass at the top and posterior region of the right atrium (arrow).
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Prominenz der Crista terminalis bei einem Neugeborenen
Visite/Pictorial Essay 97 Relationship between autonomic innervation in crista terminalis and atrial arrhythmia. J Cardiovasc Electrophysiol 2009; 20: 551– 557). Our baby did not show arrhythmias or other symptoms. Although PCT has not been previously described in the medical literature in newborns, it must be included as a differential diagnosis of the right atrium mass at this age. Atrium’s anatomy must be known to avoid unnecessary additional tests.
Contributor’s statement
▼
All the authors have contributed treating the patient and revi sing the manuscript.
Conflict of interest: The authors have no conflict of interest to disclose.
Downloaded by: University of Florida. Copyrighted material.
Fig. 2 2D echocardiogram showing Chiari network a and interatrial septal aneurysm b.
Fig. 3 2D echocardiogram showing long axis view of the right atrium with normal Eustachian valve a near the prominent crista terminalis b.
Pérez-Muñuzuri A et al. Prominent Crista Terminalis … Klin Padiatr 2015; 227: 96–97
Prominent Crista Terminalis in the Neonatal Period
Authors
A. Pérez-Muñuzuri, S. Fariña, A. Baña-Souto, O. López-Suárez, M. L. Couce-Pico
Affiliation
Pediatrics/Neonatology, Hospital Clínico Universitario, Santiago, Spain
The prominent crista terminalis (PCT) is an anatomical variant of the heart sometimes observed in older patients. We present a female newborn of a healthy mother with no relevant medical history. During pregnancy, a right intraatrial malformation was detected by ultrasound, establishing the suspected diagnosis of prominent Eustachian valve or tumour. At birth, echocardiogram showed an atrial septal aneurysm, a Chiari network inside the right atrium and an echogenic image located at the top and posterior surface of the right atrium ▶ Fig. 1, 2) of 6 mm, that not modified blood flow ( ● and did not change with time and was labeled as PCT. Normal Eustachian valve was checked ▶ Fig. 3). ( ● Crista terminalis is a normal fibromuscular ridge at the posterolateral region of the right atrium and has a close relationship with the sinus node (Salustri A et al. Prominent crista terminalis mimicking a right atrial mass: case report. Cardiovasc Ultrasound 2010; 8: 47). Occasionally, it
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1395664 Klin Padiatr 2015; 227: 96–97 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0300-8630 Correspondence Dr. Alejandro Pérez-Muñuzuri Pediatría Hospital Clínico Universitario Choupana s/nº Santiago Spain 15706 Tel.: + 34/981/950 162 Fax: + 34/981/950 292 [email protected] Pérez-Muñuzuri A et al. Prominent Crista Terminalis … Klin Padiatr 2015; 227: 96–97
can be prominent which can mimic other findings as a mass, thrombus (Gaudio C et al. Prominent crista terminalis mimicking a right atrial mixoma: cardiac magnetic resonance aspects. Eur Rev Med Pharmacol Sci 2004; 8: 165–168), or variants of normal structures as Chiari network or Thebesian and Eustachian valves (Akcay M et al. Prominent crista terminalis: An anatomic structure leading to atrial arrhythmias and mimicking right atrial mass. J Am Soc Echocardiogr 2007; 20: 197). Its diagnosis in adult patients can be performed by transesophageal echocardiography. However, the good transthoracic window in newborn babies could come close to a diagnosis by non-invasively echocardiogram. Although not frequently, it may be associated with other phenomena such as atrial septal aneurysm. These 2 structures can act as arrhythmogenic focus (Bolognesi M et al. A prominent crista terminalis associated with atrial septal aneurysm that mimics right atrial mass leading to arrhythmias: a case report. J Med Case Rep 2012; 6: 403) (Zhao QY et al. Fig. 1 2D echocardiogram showing an echogenic mass at the top and posterior region of the right atrium (arrow).
Downloaded by: University of Florida. Copyrighted material.
Prominenz der Crista terminalis bei einem Neugeborenen
Visite/Pictorial Essay 97 Relationship between autonomic innervation in crista terminalis and atrial arrhythmia. J Cardiovasc Electrophysiol 2009; 20: 551– 557). Our baby did not show arrhythmias or other symptoms. Although PCT has not been previously described in the medical literature in newborns, it must be included as a differential diagnosis of the right atrium mass at this age. Atrium’s anatomy must be known to avoid unnecessary additional tests.
Contributor’s statement
▼
All the authors have contributed treating the patient and revi sing the manuscript.
Conflict of interest: The authors have no conflict of interest to disclose.
Downloaded by: University of Florida. Copyrighted material.
Fig. 2 2D echocardiogram showing Chiari network a and interatrial septal aneurysm b.
Fig. 3 2D echocardiogram showing long axis view of the right atrium with normal Eustachian valve a near the prominent crista terminalis b.
Pérez-Muñuzuri A et al. Prominent Crista Terminalis … Klin Padiatr 2015; 227: 96–97
