A Novel Coronary Sinus: Related Right Atrial Pseudo- Mass Mimicking the Coumadin Ridge on Neonatal Transthoracic Echocardiography: A Case Report

Abstract

Normal echocardiographic variants in neonates present a diagnostic challenge because benign intracardiac structures may mimic pathological masses. Accurate differentiation is essential to prevent unnecessary diagnostic investigations and potentially harmful treatments. Diagnostic evaluation should integrate fetal echocardiography, obstetric and delivery history, neonatal physical examination, and laboratory findings. When transthoracic echocardiography is inconclusive, additional imaging modalities, including transesophageal echocardiography, three-dimensional echocardiography, CT angiography, or cardiac MRI, may be required. Nevertheless, transthoracic echocardiography remains the most accessible, practical, and low-risk imaging technique for distinguishing normal variants from pathological findings in paediatric patients. We report a healthy, one-day-old, preterm female neonate with normal clinical and laboratory findings who exhibited several recognised normal echocardiographic variants, along with a previously undescribed normal right atrial structure resembling the Coumadin ridge typically observed in the left atrium. This case highlights the importance of recognising rare normal neonatal echocardiographic variants to improve diagnostic interpretation and guide decisions regarding further imaging evaluation