DOI:10.2214/AJR.07.3104
AJR 2008; 190:W170
© American Roentgen Ray Society
Right Ventricular Diverticula
Wen-Jeng Lee,
Shyh-Jye Chen and
Tzung-Dau Wang
National Taiwan University Hospital National Taiwan University College of
Medicine Taipei, Taiwan
WEB—This is a Web exclusive article.
Dr. Srichai and coworkers
[1] wrote an interesting
article, published in the July 2007 issue of the AJR, describing the
findings of contrast-enhanced gated cardiac CT in 15 patients with 23
incidentally noted cardiac ventricular diverticula. The diverticula were all
located in the left ventricle in the study. In this letter, we report a case
with right ventricular diverticula.
A 56-year-old woman with a history of atypical chest pain was referred for
coronary CT angiography. CT was performed using a 64-MDCT scanner (LightSpeed
VCT, GE Healthcare). Imaging was performed after multiphasic injection of
nonionic contrast medium (Omnipaque 350, GE Healthcare) through a 20-gauge
needle in the right antecubital vein at a rate of 4.0 mL/s using a dual-barrel
injector (Stellant D, Medrad). During the first phase of injection, 44 mL of
contrast medium was administered. After the first phase, 40 mL of contrast
media–saline mixture (80% contrast media and 20% saline) was injected,
and 24 mL of contrast medium–saline mixture (30% contrast medium and 70%
saline) was injected during the third phase. A 20-mL saline flush was then
administered. The scanning delay was determined by a test bolus.
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Fig. 1B —56-year-old woman with a history of atypical chest pain.
Multiplanar reformatted CT images show contractile property of diverticula in
diastolic (B) and systolic (C) phases of cardiac cycle.
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Fig. 1C —56-year-old woman with a history of atypical chest pain.
Multiplanar reformatted CT images show contractile property of diverticula in
diastolic (B) and systolic (C) phases of cardiac cycle.
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The purpose of this multiphasic injection protocol was to obtain uniform
right heart attenuation in addition to coronary artery enhancement
[2]. The coronary arteries were
patent. However, two small diverticula were incidentally noted in the right
ventricle along the inferoseptal wall (Fig.
1A). The diverticula measured 7.5 x 5.6 x 3.2 mm and
4.0 x 2.9 x 2.3 mm, respectively, during diastole (Fig. 2B). The
size of the diverticula decreased during systole and measured 4.2 x 2.4
x 1.0 mm and 4.2 x 2.4 x 1.0 mm (Fig. 2C). Right ventricular
diverticula might be missed on cardiac CT if the right ventricle is not
adequately opacified by contrast medium.
References
- Srichai MB, Hecht EM, Kim DC, Jacobs JE. Ventricular diverticula on
cardiac CT: more common than previously thought. AJR2007; 189:204
–208[Abstract/Free Full Text]
- Lee WJ, Wang TD, Chiang FT, Chen SJ, Chang CH, Liu ML. A novel
variable-rate triphasic injection contrast enhancement protocol using small
amount of contrast medium to improve visualization of the right heart for
5-second coronary CT angiography. J Cardiovasc CT2007; 1[suppl]:S27
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