Congenital absence of the pericardium encountered during thoracoscopy

Excerpt

A 68-yr-old male smoker with a new 1.4-cm peripheral left upper lobe (LUL) lesion suspicious for lung cancer on positron emission tomography imaging presented for video-assisted thoracoscopic resection. The patient gave written consent for publication of the images and video recordings. The preoperative plan was wedge resection with completion lobectomy if the frozen section confirmed malignancy. A baseline electrocardiogram (ECG) showed sinus bradycardia with a right axis deviation and concave ST elevations in V4–V5. This was consistent with a previous ECG and there was no history of angina. A preoperative echocardiogram showed normal biventricular function without valvular or pericardial abnormalities. A retrospective review of a chest X-ray (Figure 1, Panel A) showed signs of left complete pericardial agenesis (CPA) including a straightened and elongated left heart border, radiolucency separating the left ventricle and hemidiaphragm, and loss of the right heart border.¹

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