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Chiari network

Dr Henry Knipe ◉ ◈ and Dr David Carroll ◉ et al.

An uncommon anatomic variant present in the right atrium, a Chiari network refers to a filamentous, weblike structure that results from incomplete resorption of the embryologic sinus venosus.

On this page:

Article:

Epidemiology
Clinical presentation
Pathology
Radiographic features
History and etymology
Related articles
References

Epidemiology

Prevalence estimates for the general population vary widely, ranging from 2% - 10% of randomly selected, asymptomatic patients ².

Clinical presentation

While thought to be of no innate clinical significance, the presence of a Chiari network is associated with the following ³:

tricuspid regurgitation
infectious endocarditis
embolic transient ischemic attack and/or stroke
- requires presence of patent foramen ovale

Pathology

Resorption of the right valve of the embryologic sinus venosus occurs during the normal development of the right atrium, forming the Eustachian valve and the crista terminalis. Incomplete resorption, however, may result in either the persistence of a prominent Eustachian valve or a Chiari network, which shares the same point of anatomical attachment but differs in appearance.

Radiographic features

Echocardiography

A Chiari network may be visualized with both transthoracic (TTE) or transesophageal (TEE) approaches, most often an incidental finding when the former is utilized to investigate an unrelated pathology.

Transthoracic echocardiography

Multiple transthoracic windows and views should be used to adequately assess the right atrium, including the apical 4 chamber view, parasternal right ventricular inflow tract view, and a basally angulated parasternal short axis view. The following grey scale features are characteristic of a Chiari network;

reticulated network of hyperechoic membranous structures located within the right atrium
- typically originates in the most posterior extent of the right atrium (RA), extending a variable distance medially and inferiorly
- may be attached to various other structures within the RA, including the interatrial septum
freely mobile throughout systole and diastole
- absence of diastolic migration into the right ventricle (RV) or the right ventricular outflow tract (RVOT)
most often tethered to the orifice of the inferior vena cava, around which it may appear to rotate ¹

History and etymology

Originally described in 1897 by the Austrian pathologist Dr. Hans Chiari (1851-1916) ⁴.

References

Anatomy: Thoracic

thoracic skeleton
- thoracic cage
  - ribs
    - typical ribs
    - atypical ribs
    - variant anatomy
      - bifid ribs
  - costal cartilage
  - sternum
- thoracic spine
- articulations
muscles of the thorax
spaces of the thorax
thoracic viscera
blood supply of the thorax
- arteries
  - thoracic aorta (development)
  - pulmonary trunk
    - left pulmonary artery
      - aberrant left pulmonary artery
    - right pulmonary artery
- veins
  - superior vena cava (cavoatrial junction)
  - inferior vena cava
  - coronary veins
    - cardiac veins which drain into the coronary sinus
      - great cardiac vein
      - middle cardiac vein
      - small cardiac vein
      - posterior vein of the left ventricle
      - vein of Marshall (oblique vein of the left atrium)
    - anterior cardiac veins
    - venae cordis minimae (smallest cardiac veins or thebesian veins)
  - pulmonary veins
    - bronchial veins
lymphatics
innervation of the thorax

Article information

rID: 68142

System: Cardiac

Section: Anatomy

Tag: cases, variant, cardiac, heart, chiari, echocardiography, echo

Synonyms or Alternate Spellings:

Chiari web
Chiari's network

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