Pericardial agenesis - partial

Case contributed by Dr Michael Burns

Presentation

Chronic cough. Incidental finding on chest X-ray.

Patient Data

Age: 40 years
Gender: Female
X-ray

PA and lateral views.  

Heart is displaced to the left. Abnormal interposition of lung between the left pulmonary artery and arch. No pulmonary artery dilatation. Abnormal lucency between the left ventricle and left hemidiaphragm. Findings are most in keeping with pericardial agenesis or defect. 

The lungs are clear.  

No acute bony abnormality.

Further evaluation via contrast-enhanced chest CT is recommended.

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. 

Case Discussion

Case of partial pericardial agenesis, also referred to as pericardial defect. This patient had no relevant symptoms.

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