Congenital diverticulum of the left ventricle – diagnosis with echocardiography, ventriculography and magnetic resonance imaging: clinical case

Abstract

Myocardial diverticula are rare and incidental fi ndings. They are most probably congenital anomalies of the cardiac wall, mainly of the left ventricle (LV), which in the majority of the cases are associated with other anomalies – cardiac, vascular or thoraco-abdominal. The lack of specifi c clinical symptoms and electrocardiographic changes in the presence of cardiac diverticulum, make them most commonly an incidental fi nding during a diagnostic imaging examination. The diagnosis of LV diverticulum can be made with echocardiography, left ventriculography, computed tomography or magnetic-resonance imaging (MRI). Among all, MRI gives the best morphologic assessment of the ventricular wall, the location and the relation of the diverticulum to surrounding structures and its dynamic behaviour during systole and diastole. MRI can rule out infl ammatory, traumatic and ischemic cardiac pathology, and cardiomyopathy, and thus differentiate the diverticulum from another entity – myocardial crypts, pathologically formed focal aneurysm or pseudoaneurysm of the LV. Therefore, MRI is the preferred non-invasive method for evaluating the cardiac wall in detail and helps to differentiate and defi nitively diagnose congenital cardiac diverticulum, which in most cases does not require therapeutic intervention.