Cordoni Gabriele, De Amicis Morena, Savo Maria Teresa, Motta Raffaella
Department of Cardio-Thoraco-Vascular Sciences and Public Health, Cardiology Unit, University of Padua, Padua, Italy.
Department of Cardio-Thoraco-Vascular Sciences and Public Health, Radiology Unit, University of Padua, Padua, Italy.
J Cardiovasc Echogr. 2024 Oct-Dec;34(4):228-231. doi: 10.4103/jcecho.jcecho_57_24. Epub 2024 Dec 19.
Around 25%-40% of ischemic strokes are cryptogenic, with no identifiable cause despite thorough evaluation. The mechanisms behind cryptogenic strokes are often embolic, frequently originating from occult cardiac sources. An unroofed coronary sinus (UCS), a rare congenital anomaly, involves a partial or complete absence of the coronary sinus roof, leading to a connection between the left atrium and the coronary sinus. This defect can be asymptomatic or present with symptoms such as paradoxical embolism due to shunting. We present the case of a 70-year-old male with prolonged chest pain and a history of neurological symptoms, who was later diagnosed with a UCS (types III and IV) through cardiac computed tomography (CCT). A cardiac bubble test confirmed a right-to-left shunt, which was not detected on transthoracic echocardiography. This case underscores the importance of considering advanced imaging techniques such as CCT in the diagnosis of cryptogenic stroke, as echocardiography may miss defects due to poor visualization of posterior cardiac structures.
约25%-40%的缺血性中风病因不明，尽管经过全面评估仍无法确定病因。不明原因中风背后的机制通常是栓塞性的，常常源于隐匿的心脏来源。无顶冠状静脉窦（UCS）是一种罕见的先天性异常，涉及冠状静脉窦顶部部分或完全缺失，导致左心房与冠状静脉窦之间存在连接。这种缺陷可能无症状，也可能因分流出现反常栓塞等症状。我们报告一例70岁男性病例，该患者有长期胸痛及神经症状病史，后来通过心脏计算机断层扫描（CCT）诊断为UCS（III型和IV型）。心脏气泡试验证实存在右向左分流，经胸超声心动图未检测到该分流。该病例强调了在不明原因中风诊断中考虑使用CCT等先进成像技术的重要性，因为超声心动图可能因心脏后部结构显示不佳而漏诊缺陷。
