Heart, Lung and Circulation
Images in CT Surgery and Cardiology| Volume 18, ISSUE 5, P362-363, October 2009

Congenital Partial Absence of the Left Pericardium Suspected on the Classical Chest X-ray

      Congenital absence of the left pericardium is a rare phenomenon occurring as a result of abnormal embryologic development of the left cardinal vein which normally develops into the left pleuropericardial membrane. Congenital pericardial defects can occur alone or in association with other congenital anomalies. Although diagnosis with conventional imaging techniques is difficult to make, this condition can be identified through chest X-ray by: (1) levo-rotation of the heart with displacement of the apex to the left, (2) linear shape of the left cardiac silhouette with erasure of the aortic knob, and (3) a flattened right cardiac silhouette in the absence of longstanding tricuspid valve regurgitation. Fig. 1 displays the above mentioned signs in an 18-year-old lady who underwent surgical closure of an ostium secondum atrial septal defect, in whom diagnosis of congenital partial absence of the left pericardium was suspected preoperatively.
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      Fig. 1(A) Preoperative chest X-ray showing: (1) the leftward displacement of the heart, (2) a linear shape of the left cardiac silhouette (arrow), and (3) a flattened right cardiac silhouette by erasure of its normally lower convexity (solid arrow). (B) Operative surgeon's view after median pericardiotomy showing congenital partial absence of the left pericardium; note the inferior left lower pulmonary lobe (asterisk).
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