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A 50 year old woman with end stage renal disease status post renal transplant presented with chest pain and was found to have coronary artery disease on coronary angiography. During performance of a left ventriculogram with a hand injection using a JR4 catheter, serendipitous cannulation and injection of a large thebesian vein occurred with prompt visualisation of cardiac veins and the coronary sinus. There was a large thebesian “venous lake” connection between the endocardial surface of the ventricle and the coronary sinus (panel). Such “venous lake” connections have not been reported before. Thebesian veins can be communications between the capillary bed to the ventricles, direct arterial connection to the ventricles or venoluminal vessels, or direct communication from the coronary vein into the ventricles. Venoluminal thebesian veins are thought to be more common in the atria than in the ventricle, and more common in the right ventricle than the left ventricle.
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