The heart is displaced to the left, the aortic arch is midline as is the descending aorta. The pulmonary conus shows apparent medial herniation or interposition of lung anteriorly between the pulmonary trunk and aorta. Pericardium is very difficult to discern, there may be thin pericardium on the right anterior to the lower right atrium but appears discontinuous anteriorly. The appearance is consistent with congenital absence or defect in the left pericardium.