IMAGES IN CARDIO-THORACIC SURGERY
European Journal of Cardio-Thoracic Surgery 42 (2012) 1054 doi:10.1093/ejcts/ezs322 Advance Access publication 31 May 2012
A rare cause of chest pain: a partial congenital absence of the pericardium Maria Iannellia,b,c, Duccio Di Carloa,b,c,*, Aurelio Secinaroa,b,c and Alberto Villania,b,c a b c
Department of Pediatric Medicine, Ospedale Pediatrico Bambino Gesù, Rome, Italy Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy Department of Imaging, Ospedale Pediatrico Bambino Gesù, Rome, Italy
* Corresponding author. Department of Pediatric Cardiology, Ospedale Pediatrico Bambino Gesù, Piazza S, Onofrio 4, 00165 Roma, Italy. Tel: +39-668592465; fax: +39-668592257; e-mail:
[email protected] (D. Di Carlo). Received 2 March 2012; received in revised form 6 April 2012; accepted 14 April 2012
Keywords: Pericardium • Chest pain • Congenital • Patch repair
A 17-year-old boy presented with a history of chest pain and dizziness. Chest X-ray and computed tomography scan suggested the diagnosis of an absent left pericardium (Fig. 1).
The defect was repaired under cardiopulmonary bypass with a polytetrafluoroethylene (PTFE) patch (Fig. 2). One year later, the patient has no physical limitations.
Figure 1: Interposition of the lung lingular parenchyma at the aortopulmonary window (arrow) in the computed tomography scan of the thorax with a contrast injection (B), visible as a hyperlucency at the chest X-ray (A), suggesting a congenital absence of the left pericardium.
Figure 2: Intraoperative view. Preoperative view (A), the cardiac mass is markedly displaced in the left pleural space (arrowhead), and the upper lobe lingula is visible (asterisk). The operation was conducted under cardiopulmonary bypass on a beating heart. After repair (B), the PTFE patch is shown (arrowhead), filling the large pericardial defect. The left lung is no longer visible. Note the rightward shift of the cardiac mass to a central position in the mediastinum.
© The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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