대한흉부영상의학회 Weekly Chest Cases

Case No : 703 Date 2011-04-19

Courtesy of Eun Young Kim, MD / Gachon University Gil Hospital
Age/Sex 23 / F
Chief Complaintcough and sputum for several days

Figure 1
Figure 2
Figure 3

Figure 1

Diagnosis With Brief Discussion

Diagnosis: Congenital absence of pericardium (Pericardial defect)
Radiologic Findings: Chest PA (figure 1) shows mild leftward displacement of the heart and prominent left upper cardiac margin. Chest CT scans (figure 2 and 3) show lateral and leftward displacement of the heart and bulging of the left atrial appendage (LAA), due to absence of the left pericardium. Interposition of lung tissue is noted between the pulmonary trunk and LAA.
Brief Review: Congenital absence of the pericardium is rare. Most pericardial defects are partial and occur on the left side. Normally, the aortopulmonary window is covered by pericardium and contains some fat. Left-sided absence of the pericardium allows interposition of lung tissue between the aorta and the main segment of the pulmonary artery. Occasionally, there is bulging of the left atrial appendage through the defect. The heart usually rotates toward the left. Complications of congenital pericardial defect may include herniation and entrapment of a cardiac chamber, especially the left atrial appendage. Associated congenital abnormalities include atrial septal defect, patent ductus arteriosus, mitral valve stenosis, and Tetralogy of Fallot. Patients who have a pericardial defect without associated congenital abnormalities are often asymptomatic.
References: 1. Victor Pineda, Jordi Andreu, Jose Caceres, Xavier Merino, Diego Varona, and Rosa Dominguez-Oronoz. Lesions of the Cardiophrenic Space: Findings at Cross-sectional Imaging. RadioGraphics 2007 27: 19-32.
2. Zhen J. Wang, Gautham P. Reddy, Michael B. Gotway, Benjamin M. Yeh, Steven W. Hetts, and Charles B. Higgins. CT and MR Imaging of Pericardial Disease. RadioGraphics 2003 23: 167S-180S.
Keywords: Pericardium, Congenital,

No. of Applicants : 78

▶ Correct Answer : 14/78, 17.9%

- Okayama University , Japan Akihiro Tada
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Assam Medical college , India samudra borah
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Hangang sacred heart hospital , Korea (South) You Mie Han
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Himchan hospital , Korea (South) Kwon Hyoung Kim
- IRSA , France jean-luc BIGOT
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Hanyang University Hospital , Korea (South) Jina Park
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- Hanyang university medical center , Korea (South) YOONAH SONG

▶ Correct Answer as Differential Diagnosis : 3/78, 3.8%

- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- All India Institute of Medical Sciences , India Ashish Gupta

▶ Semi-Correct Answer : 1/78, 1.3%

- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 703 Date 2011-04-19

Discussion

No. of Applicants : 78