TEE with Doppler flow-pattern analysis can help differentiate a muscular type of LV diverticulum from a postinfarct LV pseudoaneurysm.
Incidental LV outpouchings warrant TEE differentiation from pseudoaneurysm; leaves open natural history and management of isolated adult cases.
Isolated congenital left ventricular diverticulum (LV) is reportedly a rare finding. It is frequently associated with other congenital defects involving heart, pericardium, sternum, diaphragm, and abdominal wall. It is an outpouching from the ventricle and has all three layers of left ventricular free walls. We present the case of a 53-year-old woman who was discovered to have an outpouching of the LV apex on a nongated chest CT scan raising possibility of a pseudoaneurysm. A transesophageal echocardiogram (TEE) showed systolic diminution of this outpouching with unique Doppler flow-patterns suggesting a diagnosis of a muscular type of LV diverticulum instead of a postinfarct LV pseudoaneurysm. The patient was reassured and treated conservatively.
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Shafter et al. (2016) studied this question.
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