Upcoming Events
Log In
Pricing
Free Trial

LVNC: Focal

HIDE
PrevNext

0:01

This next case is an example of focal left ventricular noncompaction.

0:05

So left ventricular noncompaction is most

0:07

often seen like the previous case, where you have a dilated left ventricle,

0:12

somebody who has a dilated cardiomyopathy in general.

0:16

And the whole of the left ventricle is

0:19

showing areas of hypertrabeculation compared with noncompaction.

0:24

Sometimes, though,

0:25

you encounter a more focal process of left ventricular noncompaction.

0:29

I've seen it not infrequently in patients

0:32

with congenital heart disease, you can see areas of the left ventricle

0:36

which didn't seem to form normally and those seem to be less extensive

0:42

and are often associated with other congenital defects.

0:45

This patient actually, interesting, was a 57-year-old patient with a mixed

0:49

picture of left ventricular noncompaction and hypertrophic cardiomyopathy.

0:52

And what we saw on this particular patient was that they had this whole area

0:56

in the lateral wall of the left ventricle here from mid cavity to base,

1:00

where you see all this sort of disorganized appearance of the lateral

1:04

wall with relatively normal contraction but lots and lots of trabeculation.

1:10

So this is an alternative pattern

1:12

of noncompaction I've seen where you have relatively preserved function but a sort

1:17

of disorganized appearance to the left ventricular wall.

1:20

When we look on the short-axis cine

1:22

images, we see a similar kind of appearance where you have kind

1:25

of a regular disorganized appearance to the wall.

1:28

The compacted part of the myocardium is certainly very thin.

1:32

If you look here on the static images,

1:35

the compacted part of the myocardium is just paper thin right here.

1:39

And then if you were to actually measure the ratio of compacted myocardium

1:44

to normal myocardium, you'd probably end up with something like this.

1:48

This is your compacted myocardium

1:49

and your noncompacted myocardium probably extends out to here.

1:53

So some sort of ratio like this to this,

1:56

which would certainly give you a ratio greater than 2.3. I think you would see

2:00

the more than two segments of involvement because this case does involve both

2:04

the basal segments here and the mid cavity segments in the lateral wall.

2:09

It's an unusual pattern and a little different from what we saw on the previous

2:13

case, which is the more typical appearance.

2:15

So I just wanted to show this as

2:16

an example of a variant of noncompaction that you could encounter.

2:21

On delayed enhancement or late gadolinium enhancement,

2:24

this patient actually happened to have

2:25

some late enhancement in the region of noncompaction, which again can occur

2:31

here in the subendocardial region and then several foci within the trabeculations

2:35

themselves. Can occur, but again is non specific

2:38

and doesn't necessarily really help you with making that diagnosis.

2:42

So this is an example of a patient, an older patient with combined left

2:47

ventricular noncompaction and hypertrophic cardiomyopathy.

2:50

And the left ventricular noncompaction is in this focal pattern where you have areas

2:55

of sort of a disorganized left ventricular wall with thin compacted myocardium.

Report

Faculty

Stefan Loy Zimmerman, MD

Associate Professor of Radiology and Radiological Science

Johns Hopkins Medicine Department of Radiology and Radiological Science

Tags

Myocardium

MRI

Congenital

Cardiac

© 2024 Medality. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy