Cardiac Outpouchings

Abstract

Cardiac outpouchings pose a diagnostic challenge when encountered in practice, as the signs, symptoms, and initial investigations, such as radiographs and electrocardiogram, are nonspecific. They may remain asymptomatic and be incidentally detected. However, a few may present with progressive shortness of breath, thromboembolic complications, arrhythmias, pressure effects, rupture, or even death. Imaging is of paramount importance in establishing an accurate diagnosis, delineating morphology and extent of the lesion along with its hemodynamic significance, planning management, and in the follow-up.

Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach

“…Diverticula. Cardiac diverticula are described as congenital outpouchings which contain all three layers of cardiac wall (endocardium, myocardium, and pericardium) and display a synchronous contractility with the corresponding cardiac chamber, as compared to aneurysms and pseudoaneurysms (which are akinetic or dyskinetic outpouchings) [1,28]. Although no recent reports have been explained, the current epidemiology of cardiac diverticula and early studies showed a prevalence rate of 0.4% among 750 cardiac necropsy cases, while one analysis by multidetector computed tomography reported an increased prevalence to 2.2% [44].…”

“…ey are commonly located in the anterosuperior wall and have generally a broad neck and a smooth surface. Atrial diverticula should not be confounded with accessory atrial appendages, which are mostly located in the lateral and inferior walls (along the line of fusion between pulmonary veins and the embryonic atrial chamber), usually present a narrow neck and an irregular surface, due to the presence of pectinate muscles [1]. Cardiac diverticula are often asymptomatic and can be incidentally detected by imaging techniques.…”

“…Both of these structural findings develop perpendicularly to the endocardial border of the ventricular myocardium and do not extend beyond the epicardial boundary. For these reasons, such entities cannot be essentially encountered as cardiac outpouchings, although they may mimic their appearance, due to their morphological features [1]. Progressive advances in imaging techniques have improved the identification of myocardial crypts and recesses, with an overall prevalence of 6-7% in general population [61].…”

“…e term "outpouching" generally refers to a physiologic or pathologic evagination of a dilated structure outside the anatomic layer of an organ. In this context, cardiac outpouchings define a broad spectrum of distinctive congenital or acquired entities, whose recognition is of paramount relevance, due to their different natural history, prognostic outcomes, and therapeutic approach [1]. Several parameters, including location, morphology, size, wall motion abnormality, and tissue characterization, deserve careful consideration, in order to provide differential diagnosis for guiding physicians for proper clinical management and therapeutic strategy [2].…”