Crista terminalis
Citation, DOI, disclosures and article data
At the time the article was created Prashant Mudgal had no recorded disclosures.
View Prashant Mudgal's current disclosuresAt the time the article was last revised Mark Wanderley had no financial relationships to ineligible companies to disclose.
View Mark Wanderley's current disclosures- Terminal crest
The crista terminalis is a smooth muscular ridge in the superior aspect of the right atrium, formed following resorption of the right valve of the sinus venosus. It represents the junction between the sinus venarum, the "smooth" portion of the right atrium derived from the embryologic sinus venosus, and the heavily trabeculated right atrial appendage.
Coursing between the caval orifices, it divides the pectinate muscle origin and the right atrial appendages in the right atrium. Its identification is significant in the determination of atrial situs.
Radiographic features
The crista terminalis is found closely associated with the posterolateral right atrial wall. It divides the right atrium into smooth posteromedial and trabeculated anterolateral portions.
Echocardiography
A prominent crista terminalis may be incidentally discovered on transthoracic echocardiography, typically best visualized in the apical four chamber view. When a mass is visualized in the right atrium, features suggestive of a prominent crista terminalis include 4:
- rounded margins, closely apposing the posterolateral wall of the right atrium 5
- isoechoic to adjoining myocardium
- dynamic increase in size during atrial contraction
If transesophageal echocardiography is performed the bicaval view in the midesophageal position allows simultaneous visualization of the venae cavae, atria, and interatrial septum 6.
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Related pathology
While its presence is of no pathologic significance, unusual prominence of the crista terminalis has been associated with:
-
atrial fibrillation and/or flutter
- implicated as the ectopic focus of arrythmogenesis
- inappropriate sinus tachycardia (IST) 2
References
- 1. Caruso G, Becker AE. How to determine atrial situs? Considerations initiated by 3 cases of absent spleen with a discordant anatomy between bronchi and atria. Br Heart J. 1979;41 (5): 559-67. doi:10.1136/hrt.41.5.559 - Free text at pubmed - Pubmed citation
- 2. Kalman JM, Olgin JE, Karch MR, Hamdan M, Lee RJ, Lesh MD. "Cristal tachycardias": origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. (1998) Journal of the American College of Cardiology. 31 (2): 451-9. Pubmed
- 3. Prabhakar Rajiah, James MacNamara, Abhishek Chaturvedi, Ravi Ashwath, Nicholas L. Fulton, Harold Goerne. Bands in the Heart: Multimodality Imaging Review. (2019) RadioGraphics. 39 (5): 1238-1263. doi:10.1148/rg.2019180176 - Pubmed
- 4. Kim MJ, Jung HO. Anatomic variants mimicking pathology on echocardiography: differential diagnosis. Journal of Cardiovascular Ultrasound. 2013 Sep;21(3):103-112. DOI: 10.4250/jcu.2013.21.3.103.
- 5. Bolognesi M, Bolognesi D. A prominent crista terminalis associated with atrial septal aneurysm that mimics right atrial mass leading to atrial arrhythmias: a case report. (2012) Journal of medical case reports. 6: 403. doi:10.1186/1752-1947-6-403 - Pubmed
- 6. Ravi Rasalingam, Majesh Makan, Julio E. Perez. The Washington Manual of Echocardiography. (2012) ISBN: 9781451113402
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