case_images: PMC4834181_01
case_images: Four-chamber view in a transthoracic echocardiogram showing enlargement of
  the left ventricle (LV) (The LV apical structure was unclear in this view)
case_images: ARYA-12-050f1.jpg
case_images: PMC4834181_01_ARYA-12-050f1.jpg
case_images: f1-ARYA-12-050
case_images: Since the LV apex was not clear in the four-chamber view of the echocardiographic evaluation (Figure 1) and to study the kinetic features of the congenital malformation and its morphological characteristics, we performed contrast-enhanced cardiac MRI, using a 1.5 T whole-body scanner (Avanto, Siemens, Erlangen).
case_images: Cine cardiac magnetic resonance imaging (MRI) image in a four-chamber view
  shows bulging of the interventricular septum (IVS) toward the right ventricle (white
  arrow) and invagination of fatty material (black arrow)
case_images: ARYA-12-050f2.jpg
case_images: PMC4834181_01_ARYA-12-050f2.jpg
case_images: f2-ARYA-12-050
case_images: It also indicated invagination of fatty material and elongation of a normally functioning right ventricle around the deficient LV apex (Figure 2).
case_images: A T1-weighted image shows bright tissue replaced in the left ventricle (LV)
  apical position (white arrow), which could suggest the presence of fat replacement
case_images: ARYA-12-050f3.jpg
case_images: PMC4834181_01_ARYA-12-050f3.jpg
case_images: f3-ARYA-12-050
case_images: Black-blood T1-weighted sequences with and without fat saturation on short-axis and long-axis views were performed to assess alterations of the myocardial signals (Figure 3).
case_images: A late gadolinium enhancement (LGE) image performed 10 minutes after the
  contrast media injection showed no intramyocardial hyperenhancement area but indicated
  the presence of myocardial tissue in the out pouching; this confirmed the congenital
  nature of the diverticulum
case_images: ARYA-12-050f4.jpg
case_images: PMC4834181_01_ARYA-12-050f4.jpg
case_images: f4-ARYA-12-050
case_images: TR = 600 ms; TE = 3.4 ms; FA = 25 ; acquisition matrix = 156 x 256; FOV = 320 x 400 mm; slice number = 10 slices; and cardiac phase = mid-diastole. There were no signs of fibrosis or necrosis tissue presenting in the circumferential wall of the diverticulum showing by the delayed enhancement images (Figure 4).