A Case of Pulmonary Embolism Caused by a Large Thrombus Attached to a Chiari Network, Which Required Thrombectomy / 日本心臓血管外科学会雑誌

A 57-year-old man presented with a one-month history of dyspnea. Computed tomography revealed a pulmonary embolism, and echocardiography revealed multiple linear floating thrombi in the right atrium. An urgent surgical thrombectomy was performed, and most of the thrombi in the right atrium and bilateral pulmonary arteries were removed under cardiopulmonary bypass. The thrombi in the right atrium adhered to the linear Chiari networks. The patient was treated with rivaroxaban uneventfully and subsequently discharged on postoperative day 26. Herein, we report a case of right atrial thrombi and pulmonary embolism likely augmented by the Chiari network, which was successfully treated with surgical thrombectomy.

Two Cases of Chiari Network

A network of strands (Chiari Network) in the right atrium with attachments extending from the crista terminalis to eustachian valve and thebesian valve or sometimes to the floor of the right atrium in the region of the opening of the coronary sinus. While this congenital remnant is seldom clinically important, this membranes have been reported as site of thombus formation, and hence potential etiologies of pulmonary emboli as well as a source of entrapment of a right-heart catheter and arrhythmia. We report two cases of right atrial mass-like chiari form network incidentally detected by transthoracic echocardiography (TTE) and confirmed by transesophageal echocardiography (TEE).

Chiari Network Associated with Pulmonary Embolism: A Case Report / 日本心臓血管外科学会雑誌

The Chiari network is an embryological remnant. It has rarely clinical importance but may very infrequently cause thrombosis and some other complications. Chest pain and pulmonary thrombosis were developed in a 23-year-old man. Cardiac ultrasonography revealed Chiari network in his right atrium, and no other thrombogenic lesions were found. Although anti-coagulant therapy was performed, pulmonary thrombosis were redeveloped. Chiari network was thought the cause of chest pain and pulmonary thrombosis. Operative removal of Chiari networks performed. The patient was postoperatively free from chest pain and pulmonary thrombosis.