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DOI:10.2214/AJR.07.3491
AJR 2008; 190:W374
© American Roentgen Ray Society

Is It Ventricular Diverticulum or Closed Muscular Ventricular Septal Defect?

Mecit Kantarci1, Hasim Olgun1 and Cihan Duran2

1 Atatürk University, Erzurum, Turkey
2 Florence Nightingale Hospital, Istanbul, Turkey



 
WEB—This is a Web exclusive article.

We have read the article by Srichai et al. [1] with great interest. MDCT coronary angiography has been the focus of our studies for a long time, and we currently have several relevant publications in the literature [2, 3]. In our routine cardiac MDCT evaluations, we detected similar appearances to those in the Srichai et al. study. Currently, we have a study under way focusing on this issue. It struck our attention that the Srichai et al. study emphasizes that ventricular diverticula may be seen in all locations except the interventricular septum.


Figure 1
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  		Fig. 1A —33-year-old woman with single, closed muscular ventricular septal defect (VSD) localized to central septum. Axial (A) and sagittal (B) multiplanar reformatted MDCT angiography images from 16-MDCT single-source scanner show closed muscular VSD (arrows). LV = left ventricle, RV = right ventricle.

 


Figure 2
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  		Fig. 1B —33-year-old woman with single, closed muscular ventricular septal defect (VSD) localized to central septum. Axial (A) and sagittal (B) multiplanar reformatted MDCT angiography images from 16-MDCT single-source scanner show closed muscular VSD (arrows). LV = left ventricle, RV = right ventricle.

 
We further discussed these cases with a colleague who is a pediatric cardiologist with clinical experience and interest in the topic. In his evaluations, he stated that these appearances—particularly those related to the septum, central, apical, or marginal muscular—were very similar to those of small, closed muscular ventricular septal defects (VSDs) observed in echocardiography and catheter angiography (Figs. 1A and 1B). Likewise, in our study, the images we obtained from the study group revealed appearances of the septum location similar to those in the Srichai et al. [1] study.

We cannot tell whether those seen on the septum, for example on the apical septum, are closed muscular VSDs or diverticula. Could those seen on the septum, in particular, be the remains of closed muscular VSDs? If at least a part of those seen in that location are of the remains of a closed muscular VSD, this will affect the frequency of ventricular diverticula reported.


References
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 References
 

  1. 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]
  2. Kantarci M, Ceviz N, Sevimli S, et al. Diagnostic performance of multidetector computed tomography for detecting aorto-ostial lesions compared with catheter coronary angiography: multidetector computed tomography coronary angiography is superior to catheter angiography in detection of aorto-ostial lesions. J Comput Assist Tomogr 2007;31 : 595-599[CrossRef][Medline]
  3. Kantarci M, Duran C, Durur I, et al. Detection of myocardial bridging with ECG-gated MDCT and multiplanar reconstruction. AJR 2006;186 [6 suppl 2]:S391 -S394[Abstract/Free Full Text]

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M. B. Srichai, C. K. L. Phoon, and J. E. Jacobs
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Am. J. Roentgenol., June 1, 2008; 190(6): W375 - W375.
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