Left ventricular hypertrabeculation: a clinical enigma

Description

A woman aged 25 years was referred to cardiology for atypical chest pain. This was described as sharp non-exertional left-sided chest pain lasting a few seconds. Vitals showed BP 122/85 and pulse 87 bpm. Cardiovascular examination revealed normal S1 and S2, an S4 and no murmurs. ECG showed normal sinus rhythm. Transthoracic echocardiography showed marked trabeculation of the apical lateral segments (figure 1). Cardiac MRI confirmed these trabeculations with no diagnostic criteria for non-compaction.

Figure 1

(A) Cardiac MRI showing the short-axis view of the left ventricle (LV) demonstrating hypertrabeculation appearance (yellow arrow). (B) Two-dimensional echo short-axis view of the LV showing prominent trabeculations (yellow arrow). LV, left ventricle; RV, right ventricle.

Left ventricular (LV) hypertrabeculation is defined by the presence of three or more trabeculations apically and up to the level of papillary muscles, seen in one echocardiographic view.

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