Left ventricular diverticulum

A true diverticulum of the left ventricle refers to congenital anomaly affecting the left ventricle.

The condition typically occurs in children and if thought to occur in around 0.4% of cases based on autopsy studies.

In isolated cases, they are often asymptomatic and typically discovered incidentally.

It consists of a pouch or sac branching out from the ventricle. They have a variable size and can range from 5 mm to 80-90 mm. It it thought to arise as a developmental anomaly, starting around the 4th embryonic week. Their connection to the ventricle may be narrow or wide.

Subtypes

It can be classified into 2 types 1.

  • muscular type
    • often originates at the apex and comprises mainly muscular fibres that contract synchronously with the ventricle
    • often associated with other congenital defects
  • fibrous diverticulum: composed of mostly fibrous tissue
Associations 

They can be associated with other anatomic defects that involve the thoracoabdominal midline.

Syndromic associations include:

Apical diverticula have a higher association with other anomalies. Diverticula occur in isolation in around 30% of cases.

Location

They are commonly found in the apex and perivalvular area, although they have been reported in almost all locations of the ventricular wall with the exception of the interventricular septum 4.

CT chest / cardiac CT

Can have avariable appearance based on its size and position but in general is seen as a tubular outpouching arising from the ventricle. Some authors suggest the diagnosis can be made after exclusion of coronary arterial disease, local or systemic inflammation or traumatic aetiologies as well as cardiomyopathies 7.

They often show synchronous contractility and small diverticula can close during systole.

Cardiac MRI
Cine MRI

Often show synchronous contractility 8.

Recognised complications include:

Surgical resection is often the treatment of choice in symptomatic patients while management strategies in asymptomatic patients is often challenging. Other described treatment options include anticoagulation following after systemic embolisation, radiofrequency ablation or implantation of an implantable cardioverter defibrillator combined with class I or III antiarrhythmic drugs (e.g. in cases of associated symptomatic ventricular tachycardia) 7.

Possible imaging differential considerations include:

Share article

Article information

rID: 43217
System: Cardiac
Synonyms or Alternate Spellings:
  • Left ventricular diverticulae
  • Left ventricular diverticula
  • True diverticulum of the left ventricle
  • LV diverticulum
  • LV diverticula
  • True diverticulum of left ventricle
  • Congenital left ventricular diverticulum (CLVD)

Support Radiopaedia and see fewer ads

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.