Illustration of a heart with a highlighted coronary sinus.

The Heart's Hidden Clue: How Ultrasound Can Spot a Silent Warning Sign

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"Point-of-care ultrasound reveals a dilated coronary sinus, offering vital insights into heart health and potential complications. Here's what you need to know."

In emergency medicine, point-of-care ultrasound (POCUS) has become an indispensable tool, offering rapid insights into a patient's condition. It's particularly useful for assessing cardiac and pulmonary issues, like chest pain or shortness of breath, enabling quicker and more accurate diagnoses.

During an ultrasound examination, unexpected findings can sometimes emerge. These incidental discoveries can prove crucial, altering the course of treatment and providing a more complete picture of the patient's health. Identifying these subtle signs requires both skill and a thorough understanding of cardiac anatomy.

This article explores a case where POCUS revealed a dilated right coronary sinus, an unusual finding that prompted further investigation and ultimately contributed to the patient's diagnosis and care. Understanding the significance of this finding can empower healthcare professionals to make more informed decisions in similar situations.

Decoding the Dilated Coronary Sinus: What It Means for Your Heart

Illustration of a heart with a highlighted coronary sinus.

The right coronary sinus is a vessel responsible for draining blood from the heart muscle itself. Located in the posterior atrioventricular groove, it's typically not visible on ultrasound unless it becomes enlarged or dilated. A dilated right coronary sinus can be a subtle indicator of several underlying conditions.

In a recently published case, a 55-year-old woman presented to the emergency department with chest pain, shortness of breath and lightheadedness. Initial concerns pointed toward congestive heart failure (CHF). A point-of-care cardiac ultrasound revealed a dilated right coronary sinus, prompting further investigation.

Congestive Heart Failure (CHF): Elevated pressure in the heart can cause the coronary sinus to dilate.
Pulmonary Hypertension: Increased pressure in the pulmonary arteries can affect the right side of the heart and lead to dilation.
Right Ventricular Failure: Dysfunction of the right ventricle can cause backflow and dilation of the sinus.
Persistent Left Superior Vena Cava (PLSVC): This congenital anomaly can cause the coronary sinus to enlarge as it becomes the primary drainage route for blood from the left side of the body.
Total Anomalous Pulmonary Venous Return (TAPVR): A rare heart defect where pulmonary veins drain into the right side of the heart instead of the left.

While a dilated coronary sinus itself isn't life-threatening, recognizing it is crucial. It can point towards underlying conditions that require prompt diagnosis and management. Emergency physicians and other healthcare providers should be aware of this potential finding during cardiac ultrasound examinations.

The Bigger Picture: Why Recognizing This Subtle Sign Matters

The case highlights the importance of thorough cardiac assessments using point-of-care ultrasound. Even seemingly minor findings, like a dilated right coronary sinus, can offer valuable clues to a patient's overall condition.

Recognizing a dilated right coronary sinus can prompt further investigations, such as a formal echocardiogram, to identify the underlying cause. This can lead to earlier diagnosis and treatment of conditions like CHF or pulmonary hypertension.

By increasing awareness of this subtle ultrasound finding, healthcare professionals can improve their diagnostic accuracy and provide more comprehensive care for patients with cardiac concerns. Continuous learning and attention to detail are key to maximizing the benefits of point-of-care ultrasound in emergency medicine.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.ajem.2017.07.088, Alternate LINK

Title: Dilated Right Coronary Sinus Identified On Point-Of-Care Ultrasound

Subject: Emergency Medicine

Journal: The American Journal of Emergency Medicine

Publisher: Elsevier BV

Authors: Damali Nakitende, Michael Gottlieb

Published: 2017-10-01

Everything You Need To Know

What is point-of-care ultrasound and how is it used?

A point-of-care ultrasound (POCUS) is a rapid, bedside diagnostic tool used to assess a patient's condition quickly, especially in emergency settings. It provides immediate insights into cardiac and pulmonary issues, such as chest pain or shortness of breath. This is crucial because POCUS can help to reveal subtle signs like a dilated right coronary sinus, which can indicate underlying heart conditions.

What is the right coronary sinus and why is it important?

The right coronary sinus is a vessel located in the posterior atrioventricular groove and is responsible for draining blood from the heart muscle. It is generally not visible on an ultrasound unless it is dilated, which can suggest various underlying conditions. In the case of a dilated right coronary sinus, it's essential to investigate further because the dilation itself is not life-threatening, but it can be an indicator of underlying conditions such as Congestive Heart Failure (CHF), Pulmonary Hypertension, Right Ventricular Failure, Persistent Left Superior Vena Cava (PLSVC), or Total Anomalous Pulmonary Venous Return (TAPVR).

What conditions might cause a dilated right coronary sinus?

A dilated right coronary sinus can be an indicator of several underlying heart conditions. These include Congestive Heart Failure (CHF), where elevated pressure in the heart can cause the coronary sinus to dilate. It can also point to Pulmonary Hypertension, where increased pressure in the pulmonary arteries affects the right side of the heart, leading to dilation. Right Ventricular Failure, or dysfunction of the right ventricle, can cause backflow and dilation of the sinus. PLSVC can also cause the coronary sinus to enlarge as it becomes the primary drainage route. Furthermore, Total Anomalous Pulmonary Venous Return (TAPVR) is a rare heart defect that can cause dilation.

Why is recognizing a dilated right coronary sinus important?

Recognizing a dilated right coronary sinus is significant because it serves as a crucial clue during cardiac assessments. It can prompt further investigations, guide treatment decisions, and highlight the importance of comprehensive cardiac assessments. Identifying this subtle sign helps healthcare professionals to make more informed decisions, providing a more complete picture of the patient's health, and ultimately improve patient outcomes. It underscores the importance of thorough cardiac assessments using point-of-care ultrasound.

What happens after a dilated right coronary sinus is identified?

If a dilated right coronary sinus is observed on a point-of-care ultrasound, the next steps involve further investigation to identify the underlying cause. This could include additional imaging tests, blood work, and a detailed review of the patient's medical history and symptoms. The healthcare provider will need to determine which underlying condition is causing the dilation, such as CHF, Pulmonary Hypertension, Right Ventricular Failure, PLSVC, or TAPVR. The diagnosis guides the subsequent treatment plan, which may include medications, lifestyle changes, or other interventions. Early and accurate diagnosis is essential to manage the underlying condition.