The coronary sinus (CS) can be imaged echocardiographically as a small tubular sonolucency in the posterior atrioventricular groove. To date, its importance to echocardiographers has been that CS dilatation usually signifies a persistent left superior vena cava. Recently, we developed a technique to image CS caliber over the duration of the cardiac cycle. CS contraction accompanies the P wave on the electrocardiogram, in sinus rhythm or in various arrhythmias. CS contraction is always absent in atrial fibrillation. In sinus rhythm, CS contraction may be attenuated or absent if congestive heart failure, with marked venous congestion, is present. Thus, this attenuation is a potentially valuable echocardiographic sign of elevated central venous pressure. We demonstrate the echo visualization of CS-related structures, such as tributary veins and the Thebesian valve. The potentially useful concept of the CS as a "miniventricle" is discussed. CS blood flow can be recorded by interrogation in the right heart inflow view. The pattern of CS antegrade flow and the exceptional situation of retrograde systolic CS flow from a posteriorly directed tricuspid regurgitant jet are demonstrated.

Sonolucent spaces in close proximity to the heart are common in routine clinical echocardiographic practice, yet apart from pericardial effusions have received little attention. These clear spaces can represent left or right pleural effusions, ascites, pericardial cysts, or unusual diaphragmatic hernias. All these entities have typical echocardiographic features, including location, size, shape, and anatomic relationships to contiguous structures. In addition, loculated pericardial effusions, with or without associated tamponade, have to be considered in the differential diagnosis. In this brief review, we discuss and illustrate these various types of juxtacardiac sonolucencies.

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