Multiterritorial Systemic Embolization as the Initial Manifestation of Left Ventricular Noncompaction Cardiomyopathy

Left ventricular noncompaction cardiomyopathy (LVNC) is a rare myocardial disorder characterized by excessive trabeculation and deep intertrabecular recesses. Thromboembolic complications are recognized but usually involve a single vascular territory. A 42-year-old man presented with new-onset heart failure and severe left ventricular systolic dysfunction. Transthoracic echocardiography revealed marked trabeculation compatible with LVNC and a mobile apical thrombus. During hospitalization, the patient developed an acute ischemic stroke due to right middle cerebral artery occlusion, followed by the detection of bilateral renal infarctions, segmental pulmonary emboli, and mesenteric ischemia. Cardiac magnetic resonance imaging confirmed LVNC according to Petersen criteria. Infectious and thrombophilia workup were negative. The patient was treated with guideline-directed medical therapy for heart failure and long-term anticoagulation, with favorable clinical and imaging outcomes. LVNC should be considered in patients with unexplained multiterritorial systemic embolization. Early multimodality cardiac imaging is essential for diagnosis and management.