Three-dimensional transthoracic echocardiographic imaging of an unusual congenital left ventricular diverticulum

Excerpt

A previously healthy 18-year-old man presented with a history of fever for 3 days without any clinical findings. An absence of valvulopathies was shown on the two-dimensional (2D) transthoracic echocardiogram (TTE). A saccular structure communicating with the left ventricle in the mid inferoseptal wall, whose external layer was normal contractile myocardium, suggested congenital left ventricular (LV) diverticulum (Fig. 1a; Movies 1, 2). Cardiac computed tomography (CT) (Fig. 1b) confirmed the presence of a diverticulum and normal coronary anatomy. A trabecula-like structure was present inside the diverticulum (Fig. 1a; Movies 1, 2). Using additional three-dimensional (3D) TTE with an M5S-D matrix-array transducer (1.5–4.6 MHz, GE healthcare, USA), the neck of the diverticulum was crescentic in the 3D en face view (Fig. 1c; Movies 3), with a 15 mm depth and a neck 16-mm-long × 6-mm-wide in diastole (Fig. 1d; Movies 4); A trabeculation arising from the inside endocardium was clearly defined (Fig. 1d; Movies 4). As his diverticulum was incidentally diagnosed without causing any symptoms or arrhythmia, we kept conservative approach. Three years after presentation, he was found to be well without any cardiovascular symptoms on medication for adult onset Still’s disease. Echocardiography including 3D TTE was repeated and the appearance of the unusual diverticulum with a trabecula inside was unchanged.

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