The patient was referred to the emergency department of our hospital because of an episode of acute pain in his left lower limb that had begun 2 h before. He had no history of cardiovascular disease. On physical examination, his heart rate was 120 beats/min, and his BP was 130/80 mm Hg. Cardiac sounds revealed no murmurs, and pulmonary auscultation findings were normal. The ECG showed sinus rhythm with high-voltage R waves and a T-wave inversion in leads II, III, avF, and V4-V6. The chest radiograph revealed no abnormalities. A careful examination of his left lower limb found it to be pulseless, with cool, pale skin, and delayed capillary filling. The peripheral pulse in the limb was inaudible to a hand-held Doppler device. IV heparin was administered immediately, and the patient was taken to surgery. He underwent a successful surgical thromboembolectomy from the left femoral artery, and his remaining hospitalization was uncomplicated. During the investigation for a possible embolic source, transthoracic echocardiography was performed, and it revealed a cavity at the left ventricular apex having free communication with the main left ventricular chamber (Fig 1,
top, A). The transesophageal echocardiogram clearly showed that this second cavity contracted simultaneously with the left ventricle, while no obvious thrombi were detected in the left atrium, left ventricle, or second cavity (Fig 1, bottom, B). Left cardiac catheterization revealed normal coronary arteries, and left-sided ventriculography confirmed a cavity contracting simultaneously with the left ventricle (Fig 2.
) Tc-sestamibi scintigraphic imaging showed that this second cavity had normal perfusion, and the diagnosis of left ventricular diverticulum was confirmed. Although surgical resection of the diverticulum was proposed, the patient refused. He was discharged from the hospital while receiving anticoagulation therapy.