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(Circulation. 2001;104:1447.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Congenital Absence of the Pericardium

Subha V. Raman, MD; Curt J. Daniels, MD; Steven E. Katz, MD; James M. Ryan, MD; Mark A. King, MD

From Ohio State University College of Medicine, Columbus, Ohio.

Correspondence to Subha V. Raman, MD, OSU Division of Cardiology, Dorothy M. Davis Heart and Lung Research Institute, 473 W 10th Ave, Room 230, Columbus, OH 43210. E-mail Raman-1{at}medctr.osu.edu

A 37-year-old, physically active man presented for evaluation of nonexertional chest pain. He described it as sharp, left-sided, and nonradiating. The review of systems was unremarkable. He had had no previous thoracic surgery. Physical examination revealed a nonpalpable apical impulse, with no other abnormal findings.

A chest radiograph (Figure 1) demonstrated a prominent pulmonary artery shadow, with leftward and posterior rotation of the cardiac apex. Because this configuration can be seen with congenital absence of the pericardium, an ECG-gated cardiac MRI examination was performed to look for pericardial tissue and to rule out other causes of cardiac displacement. Figure 2 shows 3 images obtained using a T1-weighted, double-inversion recovery pulse sequence on a conventional 1.5 Tesla MR scanner (General Electric Medical Systems). Figure 2A was obtained in the axial plane in the lower thoracic region; no pericardium is present over most of the heart, and the characteristic displacement of the heart into the left hemithorax with no structural abnormalities is seen. Figure 2B, which is from a more cranial axial section, demonstrates the pathognomonic presence of lung parenchyma in the usually lung-free aortopulmonary space (arrow). Finally, Figure 2C was obtained in the coronal plane and illustrates the altered relationship of the right and left ventricles to each other and to the spine. The patient has continued his activities without limitation and is not contemplating surgical intervention at this time.

View larger version (82K): [in this window] [in a new window]   Figure 1. Posteroanterior (A) and lateral (B) chest roentgenograms.

View larger version (73K): [in this window] [in a new window]   Figure 2. Cardiac MR images in the axial (A, B) and coronal (C) planes.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Huston, TX 77030.

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				M. Scheuermann-Freestone, E. Orchard, J. Francis, M. Petersen, M. Friedrich, A. Rashid, D. Shore, S. Myerson, and S. Neubauer Partial Congenital Absence of the Pericardium Circulation, August 7, 2007; 116(6): e126 - e129. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Raman, S. V. Articles by King, M. A. Search for Related Content PubMed PubMed Citation Articles by Raman, S. V. Articles by King, M. A. Pubmed/NCBI databases Medline Plus Health Information Congenital Heart Defects Related Collections Pediatric and congenital heart disease, including cardiovascular surgery Computerized tomography and Magnetic Resonance Imaging