Chiari network: a protective filter against pulmonary embolism in a case of polycythaemia

BMJ Case Rep. 2012 Apr 28:2012:bcr0520114289. doi: 10.1136/bcr.05.2011.4289.

Abstract

The Chiari network, a net-like structure within the right atrium, has been described as an embryonic remnant of no clinical significance. Its role in facilitating paradoxical arterial embolic events and as a potential site for thrombus formation however, has been reported in the literature. This case illustrates the protective filter-effect of the Chiari network in a 79-year-old Caucasian man with an unknown diagnosis of polycythaemia rubra vera who presented with clinical signs and symptoms of deep vein thrombosis. Transoesophageal echocardiogram confirmed entrapment of a thrombus within the Chiari network, which was not visualised following treatment on repeat scanning 1 month later. Here the authors describe how the Chiari network may have prevented the occurrence of a fatal massive pulmonary embolism in a patient with a high pro-thrombotic tendency, and review the current literature regarding the action of this anatomic variant as risk factor or protector.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use
  • Biomarkers / blood
  • Echocardiography
  • Electrocardiography
  • Heart Atria / anatomy & histology*
  • Humans
  • Leg / blood supply
  • Male
  • Polycythemia Vera / complications*
  • Polycythemia Vera / diagnosis
  • Pulmonary Embolism / prevention & control*
  • Vena Cava Filters
  • Venous Thrombosis / complications*
  • Venous Thrombosis / diagnosis

Substances

  • Anticoagulants
  • Biomarkers