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Different positioning of the cardiac apex during the noncontrast and contrast sequences (obtained on separate days).
Extreme leftward rotation of the cardiac axis, with the left ventricular apex pointing posteriorly and leftward on the noncontrast sequence, and leftward on the contrast images. A fold of lung is seen between the aorta and pulmonary artery. Normal right pericardium along the rightward aspect of the descending aorta and about the right atrium.
The left pericardium is completely absent. Soft tissue projection about the apex of the right ventricle which extends inferiorly beyond the expected heart borders, likely a myocardial crease projecting through a pericardial defect.