MRI findings of small isolated congenital left ventricular diverticulum

Abstract

A 37-year-old man was studied for chest pain. No abnormal findings were noted in clinical examination and chest X-rays. The electrocardiogram showed sinus rhythm of 64 bpm and ST-abnormalities (ST-T elevation) in the inferior and precordial leads. Coronary angiography was normal and left ventricular angiography revealed normal ejection fraction and a small finger-like shaped image at the inferior wall. There was not a good echocardiographic acoustic window. The patient was submitted to MRI exam in order to better define the unusual aspect. The study clearly defined a small isolated diverticulum located at mid-inferior segment of left ventricular wall [short (Panel A) and long-axis (Panel B) spin-echo image]. On dynamic images, it appeared as muscular type because of changing during cardiac contraction, with maximum diameter in diastolic phase and complete emptying during systole [dynamic cardiac images in diastole (Panels C–E) and in systole (Panels C0–E0; movies 1–3)]. No abnormality was noted both in perfusion phase post-gadolinium and in delayed images at 5–10–15–20 min. Medical therapy including cardioaspirin and beta-blocker was given and a close follow-up (3–6 months) with MRI was planned. In conclusion, MRI allows a complete assessment of congenital left ventricular diverticulum (LVD) identifying fibrous or muscular type and relationship with other cardiac structures. Because of its non-invasive nature and parameter reproducibility, MRI alone can provide excellent monitoring of LVD follow-up in patient treated with conservative approach. Panel A. Short-axis spin-echo image. Panel B. Long-axis spin-echo image. Panels C–E. Dynamic cardiac images in diastole. Panels C0–E0. Dynamic cardiac images in systole. Supplementary movie is available at European Heart Journal online. European Heart Journal Advance Access published June 2, 2006