Left ventricular diverticulum is an uncommon congenital malformation defined as a localized, contractile outpouching of the ventricular wall. It must be carefully distinguished from acquired ventricular aneurysm or pseudoaneurysm, as the diagnostic implications, management strategies, and long-term prognosis differ substantially. A 2-month-old infant was referred for advanced imaging after transthoracic echocardiography raised concern for an abnormal left ventricular contour. Cardiac CT and MRI confirmed a discrete outpouching along the basal to mid anterolateral wall, measuring approximately 2.1 cm in maximal diameter, with a neck dimension of 13–14 mm. Myocardium was clearly present overlying the outpouching, and the structure demonstrated preserved systolic contractility synchronous with the adjacent ventricular wall. No evidence of wall thinning, akinesia, dyskinesia, or delayed gadolinium enhancement was identified. Global biventricular function was preserved, and coronary anatomy was normal. The initial impression suggested a basal anterolateral LV aneurysm; however, the morphological and functional features, including intact myocardial layers and preserved contraction, were more consistent with a congenital LV diverticulum. Importantly, the absence of clinical history of ischemic, inflammatory, or traumatic insult supported this conclusion. The key differential diagnoses include congenital LV diverticulum, true aneurysm, and pseudoaneurysm. Congenital diverticula are contractile and narrow-necked, maintaining myocardial continuity. True aneurysms typically follow myocardial infarction or myocarditis and demonstrate dyskinesia and wall thinning. Pseudoaneurysms result from contained rupture, are characterized by absent myocardial continuity, and frequently have a wide neck. Careful assessment of wall, contractility, and enhancement characteristics are essential for accurate classification. On follow-up echocardiogram imaging, the diverticulum remained stable in morphology and size, without evidence of thrombus formation or functional deterioration. Conservative management with periodic surveillance was advised. This case underscores the importance of multimodality imaging in ventricular outpouchings, demonstrating how contractile morphology and myocardial integrity support the diagnosis of congenital LV diverticulum. Precise differentiation from acquired lesions prevents misclassification, informs prognosis, and guides appropriate long-term management. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Priya Sarv, Narayanasamy Sabarish, Nagpal Prashant

Keywords: Cardiac CTA, Cardiovascular, Congenital

Transposition of the great arteries (TGA) is typically described using the prefixes “D” and “L,” based on the position of the aortic root relative to the pulmonary trunk. In current practice, these prefixes are often applied as shorthand to define specific segmental combinations, such as “D-TGA” for concordant atrioventricular and discordant ventriculo-arterial connections, or “L-TGA” for congenitally corrected variants. However, atypical and mirror-image cases challenge the accuracy of this prefix-based terminology and highlight the need for full segmental description. A 4-year-old boy with a background of complex congenital heart disease presented for follow-up evaluation prior to surgical intervention. He had a known history of mirror-imaged visceral arrangement and had previously undergone a bidirectional Glenn shunt for palliation of pulmonary atresia, ventricular septal defect, and atrial septal defect. Cardiac computed tomography revealed mirror-imaged atrial arrangement, with the morphologic right atrium located on the left and the morphologic left atrium on the right. The thoraco-abdominal organs were similarly reversed, including a left-sided liver and right-sided stomach and spleen. The ventricles showed D-looping with right-handed topology, with the morphologic right ventricle on the right and morphologic left ventricle on the left. The aorta arose discordantly in a rightward and anterior position relative to the pulmonary trunk, consistent with transposition physiology in this mirror-image setting. This case demonstrates the limitations of relying solely on “D” and “L” prefixes. In this patient, the aortic root position was consistent with “D-TGA” in its original spatial sense, yet the overall physiology was that of congenitally corrected transposition due to the underlying atrioventricular and ventriculo-arterial connections. Describing the case simply as “D-TGA” would be misleading and risk miscommunication in clinical and surgical planning. This report emphasizes that accurate diagnosis and classification of TGA require comprehensive segmental analysis, including atrial arrangement, ventricular topology, and the nature of atrioventricular and ventriculo-arterial connections. The position of the aorta should be reported separately rather than equated with transposition type. Recognition of these principles is essential to avoid confusion and ensure clarity in the management of complex and mirror-image variants of congenital heart disease. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Priya Sarv, Narayanasamy Sabarish, Nagpal Prashant

Keywords: Cardiac CTA, Complex Congenital Heart Disease, Cardiovascular

Pulmonary embolism (PE) is a potentially life-threatening condition, and accurate imaging is critical for timely diagnosis. While CT pulmonary angiography is the gold standard, MR angiography (MRA) offers a radiation-free alternative, particularly important in younger patients. However, MRA is prone to artifacts that can mimic pathology and lead to false-positive interpretations. We present two cases of 15-year-old patients who presented to the emergency department with acute chest pain and underwent MRA as part of the diagnostic workup to avoid radiation exposure. In both cases, imaging demonstrated central dark signal voids within the pulmonary arteries, raising concern for thrombus. Closer review revealed these findings were attributable to Gibbs ringing artifact, which occurs due to undersampling and edge effects, producing alternating bright and dark bands that may simulate intraluminal filling defects. In one patient, additional challenges were posed by timing-related artifacts during k-space acquisition, where misalignment of contrast bolus and central k-space filling resulted in a “maki roll” appearance, further complicating interpretation. Strategies to differentiate artifact from true thrombus include correlating with multiple imaging planes, and importantly, reviewing second or delayed angiographic runs to determine whether a defect persists or resolves. In both cases, the absence of persistent findings and awareness of artifact patterns prevented misdiagnosis of PE. These cases underscore the importance of recognizing Gibbs ringing and timing-related artifacts in MRA of the pulmonary arteries. Careful image review and knowledge of common pitfalls are essential to avoid false-positive diagnoses and ensure appropriate patient management. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Priya Sarv, Narayanasamy Sabarish, Nagpal Prashant

Keywords: Cardiovascular MRA, Magnetic Resonance Imaging, Pulmonary Embolism