Multiple left ventricular inferoseptal clefts. Multimodality imaging appearance and differential diagnosis

Area of Science:

• Cardiology
• Cardiac Imaging
• Myocardial Anatomy

Background:

• Left ventricular inferoseptal clefts represent a localized variant of myocardial structure.
• These findings can be subtle and easily overlooked during cardiac imaging.
• They may raise diagnostic concerns when identified.

Observation:

• A case study of a 49-year-old male with chest pain revealed multiple inferoseptal clefts.
• Multimodality imaging including echocardiography, cardiac MRI, ventriculography, and CT visualized the clefts.
• The clefts were observed to be occluded by compact myocardium during systole.

Findings:

• Inferoseptal clefts exhibit specific location, orientation, and systolic occlusion patterns.
• These features resemble clefts seen in healthy volunteers and crypts in hypertrophic cardiomyopathy (HCM) mutation carriers.
• The diagnosis was confirmed through expert consultation and review of limited literature.

Implications:

• Multimodality imaging is crucial for accurate depiction and differentiation of inferoseptal clefts.
• It is essential to distinguish clefts from conditions such as left ventricular noncompaction cardiomyopathy (LVNC), cardiac diverticula, and aneurysms.
• Inferoseptal clefts require wider recognition as a distinct variant of left ventricular regional structure.