Right Ventricular Diverticula

Abstract

Right Ventricular Diverticula Dr. Srichai and coworkers [1] wrote an interesting article, published in the July 2007 issue of the AJR, describing the findings of contrast-enhanced gated cardiac CT in 15 patients with 23 incidentally noted cardiac ventricular diverticula. The diverticula were all located in the left ventricle in the study. In this letter, we report a case with right ventricular diverticula. A 56-year-old woman with a history of atypical chest pain was referred for coronary CT angiography. CT was performed using a 64-MDCT scanner (LightSpeed VCT, GE Healthcare). Imaging was performed after multiphasic injection of nonionic contrast medium (Omnipaque 350, GE Healthcare) through a 20-gauge needle in the right antecubital vein at a rate of 4.0 mL/s using a dual-barrel injector (Stellant D, Medrad). During the first phase of injection, 44 mL of contrast medium was administered. After the first phase, 40 mL of contrast media–saline mixture (80% contrast media and 20% saline) was injected, and 24 mL of contrast medium–saline mixture (30% contrast medium and 70% saline) was injected during the third phase. A 20-mL saline flush was then administered. The scanning delay was determined by a test bolus. The purpose of this multiphasic injection protocol was to obtain uniform right heart attenuation in addition to coronary artery enhancement [2]. The coronary arteries were patent. However, two small diverticula were incidentally noted in the right ventricle along the inferoseptal wall (Fig. 1A). The diverticula measured 7.5 × 5.6 × 3.2 mm and 4.0 × 2.9 × 2.3 mm, respectively, during diastole (Fig. 2B). The size of the diverticula decreased during systole and measured 4.2 × 2.4 × 1.0 mm and 4.2 × 2.4 × 1.0 mm (Fig. 2C). Right ventricular diverticula might be missed on cardiac CT if the right ventricle is not adequately opacified by contrast medium. Lee WJ, Chen SJ, Wang TD Wen-Jeng Lee Shyh-Jye Chen Tzung-Dau Wang National Taiwan University Hospital National Taiwan University College of Medicine Taipei, Taiwan