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A 72-year-old African American male patient with a history of alcohol abuse presented with acute encephalopathy and failure to thrive (FTT) with unintentional weight loss. His electrocardiogram showed new-onset AF. As part of his initial work up for FTT, he underwent computed tomography (CT) scan of the chest and abdomen with an incidental finding of congenital absence of the CS ostium resulting in retrograde cardiac venous blood flow through the PLSVC to the left innominate/brachiocephalic vein, into the (right) superior vena cava and back into the right atrium (Figure 1). A large thrombus measuring 2.5 cm in its largest dimension and extending into the PLSVC was detected in the coronary sinus (Figures 1 and 2). Transthoracic echocardiogram (TTE) confirmed the findings of CS thrombus with engorged cardiac veins (Figure 3). Due to high operative risk, the patient was started on anticoagulation instead of thrombectomy

Venous varices of the heart: a case report of spontaneous coronary sinus thrombosis with persistent left superior vena cava