The characteristics of left atrial diverticula in normal sinüs rhythm patients

  • Mehmet ŞekerEmail author
Original Article



The purpose of this study was to evaluate the prevalence, location, size and morphological characteristics of left atrial diverticula using electrocardiographically gated multi-detector computed tomography in patients with normal sinus rhythm.


Electrocardiographically gated cardiac multi-detector computed tomography was performed in 93 patients with normal sinus rhythm. The prevalence, number, size, morphological characteristics and location of left atrial diverticula were recorded.


A total of 72 left atrial diverticula were diagnosed in 45 (48.4%) of the 93 patients in this study. Of these 72 diverticula, 66 (91.7%) were cystiform and 6 (8.3%) were tubiform. Anterosuperior wall, left lateral wall and septum were the most common locations of these left atrial diverticula (n = 42, 58.3%; n = 22, 15.3% and n = 7, 9.7%, respectively).


Diverticula are common variations. The discovery of these structures is relatively new and their clinical significance remains unclear. They are generally asymptomatic but although not supported by many studies, in some case reports they are claimed to be associated with arrhythmias and thromboembolism. In addition, it is theoretically reasonable to think that they may cause complications during interventional procedures. Better understanding of these structures has the potential to improve management strategies and reduce potential complications. Therefore, they should be reported during routine cardiac computed tomography.


Left atrium Left atrial diverticulum Left atrial variations Cardiac computed tomography Cardiac imaging 


Author contributions

MŞ: project development, data collection, data analysis and manuscript writing. The author has approved the manuscript and agreed with its submission to Surgical and Radiologic Anatomy.

Compliance with ethical standards

Conflict of interest

The author declared no potential conflicts of interests associated with this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of institutional review committee of Istanbul Medipol University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained for all CT examinations from all individual participants included in the study.


  1. 1.
    Abbara S, Mundo-Sagardia JA, Hoffman U et al (2009) Cardiac CT assessment of left atrial accessory appendages and diverticula. AJR 193(3):807–812. CrossRefPubMedGoogle Scholar
  2. 2.
    Balli O, Aytemir K, Karcaaltincaba M (2012) Multidetector CT of left atrium. Eur J Radiol 81:e37–e46. CrossRefPubMedGoogle Scholar
  3. 3.
    Duerinckx AJ, Vanovermeire O (2008) Accessory appendages of the left atrium as seen during 64-slice coronary CT angiography. Int J Cardiovasc Imaging 24:215–221. CrossRefPubMedGoogle Scholar
  4. 4.
    Genç B, Solak A, Kantarci M et al (2014) Anatomical features and clinical importance of left atrial diverticula. Clin Anat 27(5):738–747. CrossRefPubMedGoogle Scholar
  5. 5.
    Goncalves A, Marcos-Alberca P, Zamorano JL (2009) Left atrium wall diverticulum: an additional anatomical consideration in atrial fibrillation catheter ablation. Eur Heart J 30:2164. CrossRefPubMedGoogle Scholar
  6. 6.
    İncedayı M, Öztürk E, Sönmez G et al (2012) The incidence of left atrial diverticula in coronary CT angiography. Diagn Interv Radiol 18:542–546. CrossRefPubMedGoogle Scholar
  7. 7.
    Killeen RP, O’Connor SA, Keane D et al (2009) Ectopic focus in an accessory left atrial appendage radiofrequency ablation of refractory atrial fibrillation. Circulation 120:e60–e62. CrossRefPubMedGoogle Scholar
  8. 8.
    Lee WJ, Chen SJ, Lin JL et al (2008) Accessory left atrial appendage: a neglected anomaly and potential cause of embolic stroke. Circulation 117:1351–1352. CrossRefPubMedGoogle Scholar
  9. 9.
    Nagai T, Fujii A, Nishimura K et al (2011) Large thrombus originating from left atrial diverticulum: a new concern for catheter ablation of atrial fibrillation. Circulation 124:1086–1088. CrossRefPubMedGoogle Scholar
  10. 10.
    Peng LQ, Yu JQ, Yang ZG et al (2012) Left atrial diverticula in patients referred for radiofrequency ablation of atrial fibrillation: assessment of prevalence and morphologic characteristics by dual-source computed tomography. Circ Arrhythm J Electrophysiol 5:345–350. CrossRefGoogle Scholar
  11. 11.
    Poh AC, Juraszek AL, Ersoy H et al (2008) Endocardial irregularities of the left atrial roof as seen on coronary CT angiography. Int J Cardiovasc Imaging 24:729–734CrossRefGoogle Scholar
  12. 12.
    Shin SY, Kwon SH, Oh JH (2011) Anatomical analysis of incidental left atrial diverticula in patients with suspected coronary artery disease using 64-channel multidetector CT. Clin Radiol 66:961–965. CrossRefPubMedGoogle Scholar
  13. 13.
    Troupis J, Crossett M, Scneider-Kolsky M et al (2012) Presence of accessory left atrial appendage/diverticula in a population with atrial fibrillation compared with those in sinus rhythm: a retrospective review. Int J Cardiovasc Imaging 28:375–380CrossRefGoogle Scholar
  14. 14.
    Vehian A, Choi B, Rekhi S et al (2015) Clinical significance of left atrial anatomic abnormalities identified by cardiac computed tomography. Adv Comput Tomogr 4:1–8. CrossRefGoogle Scholar
  15. 15.
    Wan YD, He Z, Zhang L et al (2009) The anatomical study of left atrium diverticulum by multidetector row CT. Surg Radiol Anat 31:191–198. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Medipol Mega Hospital, Faculty of MedicineIstanbul Medipol UniversityIstanbulTurkey

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