IMAGE FOCUS
doi:10.1093/ehjci/jex141
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A rare pathological entity of right ventricular diverticulum Yukiho Hirota, Takeshi Sugimoto, Tetsuya Nomura*, and Tetsuya Tatsumi Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan * Corresponding author. Tel: 181 (0771) 42 2510; Fax: 181 (0771) 42 2096. E-mail: [email protected]
A 61-year-old woman underwent contrast-enhanced computed tomography (CT) as a preoperative examination for gastric cancer and a right ventricular outpouching was incidentally detected. She had no medical history of myocardial infraction nor myocarditis. Coronary angiography showed no significant stenosis, and no myocardial disorders were shown on myocardial scintigraphy. We used multiple imaging modalities such as CT (Panels A and B), right ventriculography (Panel C), echocardiography (Panels D–G), and cardiac magnetic resonance imaging (Panels H and I). The outpouching communicated with the right ventricle (RV) at the apex through a small orifice. Due to a lack of myocardium in its wall, it exhibited no contractile function. Doppler echocardiography showed outflow from the RV on systole and inflow into the RV on diastole. We diagnosed it as a right ventricular diverticulum. We decided to regularly observe about this lesion without intervention.
There have been discussions about differential diagnosis between ventricular aneurysm and diverticulum. A ventricular aneurysm is thought to be caused by factors such as myocardial infarction, myocarditis, pericarditis, surgery, and trauma, whereas ventricular diverticula are always congenital. A diverticulum on the RV is very rare, and there is no established treatment policy for this pathological entity. A timedependent increase in the size of the diverticulum is an anatomical sign of rupture, and it usually requires surgical treatment. Therefore, a careful follow-up and timely surgical intervention to avoid rupture should be considered. Supplementary data are available at European Heart Journal—Cardiovascular Imaging online. C The Author 2017. For permissions, please email: [email protected]. Published on behalf of the European Society of Cardiology. All rights reserved. V
doi:10.1093/ehjci/jex141
....................................................................................................................................................
A rare pathological entity of right ventricular diverticulum Yukiho Hirota, Takeshi Sugimoto, Tetsuya Nomura*, and Tetsuya Tatsumi Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan * Corresponding author. Tel: 181 (0771) 42 2510; Fax: 181 (0771) 42 2096. E-mail: [email protected]
A 61-year-old woman underwent contrast-enhanced computed tomography (CT) as a preoperative examination for gastric cancer and a right ventricular outpouching was incidentally detected. She had no medical history of myocardial infraction nor myocarditis. Coronary angiography showed no significant stenosis, and no myocardial disorders were shown on myocardial scintigraphy. We used multiple imaging modalities such as CT (Panels A and B), right ventriculography (Panel C), echocardiography (Panels D–G), and cardiac magnetic resonance imaging (Panels H and I). The outpouching communicated with the right ventricle (RV) at the apex through a small orifice. Due to a lack of myocardium in its wall, it exhibited no contractile function. Doppler echocardiography showed outflow from the RV on systole and inflow into the RV on diastole. We diagnosed it as a right ventricular diverticulum. We decided to regularly observe about this lesion without intervention.
There have been discussions about differential diagnosis between ventricular aneurysm and diverticulum. A ventricular aneurysm is thought to be caused by factors such as myocardial infarction, myocarditis, pericarditis, surgery, and trauma, whereas ventricular diverticula are always congenital. A diverticulum on the RV is very rare, and there is no established treatment policy for this pathological entity. A timedependent increase in the size of the diverticulum is an anatomical sign of rupture, and it usually requires surgical treatment. Therefore, a careful follow-up and timely surgical intervention to avoid rupture should be considered. Supplementary data are available at European Heart Journal—Cardiovascular Imaging online. C The Author 2017. For permissions, please email: [email protected]. Published on behalf of the European Society of Cardiology. All rights reserved. V
