Pericardial agenesis - the wandering heart

• Published in: The Egyptian heart journal Vol. 75; no. 1; p. 79
• Main Authors: Kalekar, Tushar, Reddy, Latha P., Koganti, Deepak, Soman, Nikhith
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 19.09.2023; Springer; Springer Nature B.V; SpringerOpen
• Subjects: Agenesis; Cardiac MRI; Cardiology; Case Report; Chest pain; Chest X-ray; Congenital diseases; Coronary vessels; Electrocardiogram; Electrocardiography; Heart; Heart attack; Magnetic resonance imaging; Medicine; Medicine & Public Health; Myocardial infarction; Patients; Pericardial agenesis; Pericardium; Pulmonary arteries; Veins & arteries; Weightlifting; X-rays; Myocardial infarction; Pericardial agenesis; Cardiac MRI; Chest X-ray
• ISSN: 2090-911X; 1110-2608; 2090-911X
• DOI: 10.1186/s43044-023-00405-x

Background Congenital pericardial absence is an uncommon cardiac anomaly that is typically asymptomatic and commonly misdiagnosed due to a lack of symptoms or atypical symptoms. Pericardial agenesis (PA) should be considered one of the differential diagnoses when the patient presents with chest pain. This case shows how the diagnosis of pericardial agenesis is made exclusively using multi-modality imaging, starting from findings in a basic chest radiograph to cardiac MRI, while also demonstrating the classic signs seen in this condition. Magnetic resonance imaging of the heart is the gold standard for determining the absence of pericardium in the prognosis. Case presentation A 32-year-old male who presented with chest discomfort and radiating pain to his back and left shoulder mimicking myocardial infarction with normal ECG and enzyme markers. A chest radiograph (taken 24 h apart) demonstrates the left lateral position of the heart and the bulging contour of the left heart border, a lucent area between the aorta and pulmonary artery. Subsequently, cardiac MRI reveals left pericardial agenesis. Conclusions This article provides insight into a rare differential to consider in a young patient presenting with chest discomfort. This case shows how the diagnosis of pericardial agenesis is made exclusively using multi-modality imaging, starting from findings in a basic chest radiograph to cardiac MRI, while also demonstrating the classic signs seen in this condition.