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J Cardiovasc Echogr. 2019 Jan-Mar;29(1):32-34. doi: 10.4103/jcecho.jcecho_65_18.

A Nonfatal Massive Pulmonary Embolism in a Very Old Patient: The Protective Filter-Effect of the Chiari Network.

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Department of Cardiology, San Giuseppe Multimedica IRCCS Hospital, Milano, Italy.
Department of Cardiology, Cardiology Clinic, Policlinico San Giorgio, Pordenone, Italy.
Department of Cardiovascular, MultiMedica IRCCS, Milano, Italy.


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 has been reported in the literature. This case illustrates the protective filter-effect of the Chiari network in a 92-year-old women who presented with the clinical signs and symptoms of acute cor pulmonale. Transthoracic echocardiography revealed a large, S-shaped, and extremely mobile right atrial thrombus within the Chiari network. Here, the authors describe how the Chiari network may have prevented the occurrence of a fatal pulmonary embolism acting as a protective factor.


Chiari network; pulmonary embolism; right atrial thrombus

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