PMC3020356_01
Ventriculography from the right anterior oblique caudal view. A, Arrows showing the first pass of the contrast media from the LV1 to the LV2. B, Systole. C, Diastole. The LV2 was not part of the apex (*) of the LV1.
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ICA revealed normal coronary arteries, but ventriculography showed an outpouching on the left ventricle that was thought to be an aneurysm (Fig. 1).
Cardiac magnetic resonance imaging with the perfusion technique on the same slice position of one short axis view. A, The gadolinium is first inside of the LV1. LV2 (*) does not fill in with contrast. B, The second moment shows that the gadolinium fills the LV2 but with less concentration than LV1. C, The third moment both cavities has the same signal intensity. D, There is no perfusion defect on the lateral wall of the LV2 and also at the whole myocardium.
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MRI scanner (Avanto, Siemens Medical Solutions, Erlangen, Germany) with a four-element phased-array cardiac coil using perfusion, cine-Steady-state free precession (SSFP) and delayed-enhancement sequences. MRI results confirmed the presence of the pouch, appending to the posterior and lateral wall of the left ventricle (Fig. 2).
Cardiac magnetic resonance imaging (MRI) with the cine (A, B, D, and E) and late enhancement (C and F) techniques. A, Cine-MRI, short-axis view at the apical portion of the left ventricle (LV) showing both cavities. B, Cine-MRI, short axis view at the middle portion of LV showing both cavities. C, Delayed enhancement, short-axis view at the middle portion of LV without scar/fibrosis. D, Cine-MRI four-chamber view at diastole showing both cavities. E, Cine-MRI, four-chamber view at systole showing the thickening of the lateral wall of the LV2. F, Delayed enhancement, four-chamber view without scar/fibrosis.
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As seen in Fig. 3, the pouch was separate from the apex.