Guimarães, TatianaPlácido, RuiAlmeida, Ana G.2019-09-302019-09-302019Rev Esp Cardiol. 2019;72(5):4171885-5857http://hdl.handle.net/10451/39644Published by Elsevier España, S.L.U. on behalf of Sociedad Española de Cardiología.A 36-year-old Guinean woman was referred to our center for a closer examination of systolic murmur. She had no cardiovascular complaints. Echocardiographic examinations depicted a large saccular structure at the left ventricular lateral and infer-lateral walls, in the submitral region (Figure 1). The outpouching structure was connected to the left ventricle (LV) through a large neck. In diastole, blood flowed from the LV into the cavity, and in systole blood flowed from the cavity into the LV. These findings suggested that this cavity itself contracted. No other cardiac abnormalities were found. To better delineate the whole shape of the cavity, a computed tomographic scan was requested. It allowed precise measurement of the outpouching structure (9 x 7 cm), delineation of its morphology and excluded coronary artery disease (Figure 2). To confirm whether the cavity wall consisted of muscle, a cardiac magnetic resonance study was performed; cardiac magnetic resonance cine and late gadolinium enhancement images clearly demonstrated a contractile cavity wall, consisting of muscle with no fibrosis (Figure 3). A diagnosis of large congenital submitral left ventricular diverticulum was made. The patient refused surgery and is followed up at our cardiology clinic.engjournal article10.1016/j.rec.2018.04.014