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Thebesian Veins Draining to the Left Ventricle, Mimicking Left Ventricular Noncompaction

Simon F Stämpfli1, Bart W De Boeck1, Florim Cuculi1

  • 1Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

Left ventricular noncompaction cardiomyopathy (LVNC) can be mimicked by thebesian veins. Cardiac imaging like echocardiography and cardiac magnetic resonance (CMR) should assess venous flow to avoid misdiagnosis.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Medicine

Background:

  • Left ventricular noncompaction cardiomyopathy (LVNC) is a rare genetic heart muscle disease.
  • Diagnosis typically relies on echocardiography and cardiac magnetic resonance (CMR) imaging criteria.
  • Distinguishing true LVNC from mimics is crucial for appropriate patient management.

Observation:

  • A 59-year-old woman was initially diagnosed with LVNC based on echocardiography findings.
  • Subsequent cardiac magnetic resonance (CMR) also met diagnostic criteria for LVNC.
  • Coronary angiography revealed prominent thebesian veins as the cause of the apparent noncompaction.

Findings:

  • Thebesian veins, which are small venous channels within the heart muscle, can create an appearance mimicking LVNC.
  • Echocardiography and CMR, when used with flow assessment in cardiac recesses, can help differentiate true LVNC from venous anomalies.
  • This case highlights the importance of considering alternative diagnoses when imaging findings are equivocal.

Implications:

  • Accurate differentiation of LVNC from thebesian vein anomalies is essential to prevent unnecessary treatment or patient anxiety.
  • Integrating flow assessment into cardiac imaging protocols can improve diagnostic accuracy for LVNC.
  • Further research into imaging characteristics of venous anomalies mimicking cardiomyopathies is warranted.

Keywords:
CMR, cardiac magnetic resonanceCT, computed tomographyDopplerECG, electrocardiographyHCM, hypertrophic cardiomyopathyLV, left ventricleLVEF, left ventricular ejection fractionLVNCLVNC, left ventricular noncompactioncardiomyopathycleftcryptsinusoids

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