Left ventricular (LV) noncompaction cardiomyopathy (LVNC) is a form of cardiomyopathy in which trabeculations fail to "compact" with the left ventricular endocardium during fetal cardiac development and is classically associated with subsequent impairment of LV function, significant mortality, ventricular dysrhythmias, and embolic phenomena. As awareness and medical imaging quality have improved, it is becoming easier to identify trabeculations that traverse the LV cavity and serve as a distinguishing feature of this disorder. Differentiating true noncompaction from mild increases in trabeculations requires prudent imaging and clinical correlation. This review seeks to discuss the potential methods of evaluating left ventricular trabeculations, the role of increased trabeculations in cardiovascular disease, and how their presence may affect clinical management.