https://orcid.org/0000-0002-8479-122X
A 56-year-old woman was referred to our centre to perform cardiac magnetic resonance (CMR) following an echocardiogram describing the presence of a diverticular outpouching of the apex of the right ventricle (RV), performed for an occasional finding of electrocardiogram abnormalities (T-wave inversion in inferior-lateral leads).
CMR imaging revealed a diverticular outpouching at the RV apex, with maximum diameters of 24 × 12 mm measured in horizontal long-axis (HLA) breath-hold balanced steady-state free precession (b-SSFP) cine sequences (Panel A). HLA and axial cine b-SSFP (Panels A and B) showed that the diverticular wall maintained a normal contractility, and normal blood flow was observed inside the cavity, excluding the hypothesis of an aneurysm or pseudo-aneurysm. Furthermore, left ventricular (LV) apex showed a pseudo-diverticular shape without clear evidence of outpouching (three-chamber long-axis b-SSFP, Panel C). A small myocardial crypt was observed at the LV inferior basal wall (vertical long-axis b-SSFP, Panel D); normal myocardial thickness and normal biventricular volumes and function were confirmed.
Early gadolinium enhancement sequences excluded the presence of thrombus inside the diverticulum (Panel E). Late gadolinium enhancement (LGE) sequences (Panel F) did not show any wall enhancement at the outpouching site, confirming the diagnosis of a congenital apical diverticulum in the RV. Additionally, LGE sequences demonstrated normal tissue signal in all the other myocardial regions.
CMR imaging allowed to reach the diagnosis by providing information on contractility of the diverticular wall, giving a correct anatomical localization and excluding the hypothesis of aneurysm or pseudo-aneurysm.
Supplementary data (b-SSFP cine video) are available at European Heart Journal - Cardiovascular Imaging online.
Funding: None declared.
Data availability: The data underlying this article will be shared upon reasonable request addressed to the corresponding author.
Author notes
Conflict of interest: None declared.
