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Marzullo R, Capestro A, Cosimo R, Fogante M, Aprile A, Balardi L, Giordano M, Gaio G, Gauderi G, Russo MG, Schicchi N. Congenital Absence of Pericardium: The Swinging Heart. J Imaging 2024; 10:199. [PMID: 39194988 DOI: 10.3390/jimaging10080199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
Congenital absence of the pericardium (CAP) is an unusual condition discovered, in most cases, incidentally but can potentially lead to fatal complications, including severe arrhythmias and sudden death. Recently, the use of modern imaging technologies has increased the diagnosis of CAP, providing important findings for risk stratification. Nevertheless, there is not yet consensus regarding therapeutic decisions, and the management of patients with CAP remains challenging. In this paper, we discuss the pathophysiological implication of CAP, review the current literature and explain the role of multimodality imaging tools for its diagnosis, management and treatment.
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Affiliation(s)
- Raffaella Marzullo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, 81100 Naples, Italy
| | - Alessandro Capestro
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, University Hospital of Marche, 60126 Ancona, Italy
| | - Renato Cosimo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, 81100 Naples, Italy
| | - Marco Fogante
- Department of Radiology, Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, University Hospital of Marche, 60126 Ancona, Italy
| | | | - Liliana Balardi
- Health Professions Area and Diagnostic Technical Area, University Hospital of Marche, 60126 Ancona, Italy
| | - Mario Giordano
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, 81100 Naples, Italy
| | - Gianpiero Gaio
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, 81100 Naples, Italy
| | - Gabriella Gauderi
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, 81100 Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, 81100 Naples, Italy
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiology, University Hospital of Marche, 60126 Ancona, Italy
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Wang GC, Li XR, Huang N, Tian HT. Sudden ventricular fibrillation due to absence of pericardium in left upper lobectomy -a case report. Korean J Anesthesiol 2024; 77:401-404. [PMID: 38225739 PMCID: PMC11150111 DOI: 10.4097/kja.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Congenital absence of the pericardium (CAP) is a rare cardiac abnormality. As pericardial defects are usually asymptomatic, most cases are diagnosed during surgery or on autopsy. The patient in this case was found to have CAP during thoracoscope. CASE We present the unusual case of a 69-year-old patient with CAP who experienced sudden ventricular arrhythmia and developed ventricular fibrillation during left upper lobectomy. Surgical operations, the lateral decubitus position, and other external stimuli may be important risk factors for ventricular fibrillation. The patient regained sinus rhythm soon after intrathoracic cardiac compression and pharmacological treatment, including lidocaine spray (2%, 10 ml) administered to the heart surface. The surgery was then completed without any additional instances of ventricular arrhythmia. CONCLUSIONS Patients with CAP are more susceptible to cardiac-related adverse events during thoracotomy or thoracoscopy. Treatment of ventricular arrhythmias that occur during lung resection in patients with CAP should be emphasized.
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Affiliation(s)
- Guo-Cao Wang
- School of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Xi-Rong Li
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Ning Huang
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Hai-Tao Tian
- School of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
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Zhu X, Zhang L, Tang Z, Xing FB, Gao X, Chen WB. Mature mediastinal bronchogenic cyst with left pericardial defect: A case report. World J Clin Cases 2021; 9:11362-11368. [PMID: 35071567 PMCID: PMC8717515 DOI: 10.12998/wjcc.v9.i36.11362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/26/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mediastinal bronchogenic cysts and pericardial defects are both rare. It is extremely rare that both occur simultaneously. To the best of our knowledge, this is the first case of a coexistent bronchogenic cyst and pericardial defect reported in China. We performed a literature review and found a relationship between bronchogenic cysts and pericardial defects, which further revealed the correlation between the bronchus and pericardium during embryonic development.
CASE SUMMARY A 14-year-old boy attended a local hospital for ankylosing spondylitis. Chest radiography showed an enhanced circular-density shadow near the left mediastinum. The patient had no chest symptoms and the physical examination was normal. Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment. During surgery, a left pericardial defect was observed. The bronchogenic cyst was removed by thoracoscopic surgery, but the pericardial defect remained untreated, and a satisfactory outcome was achieved after the operation. The patient was diagnosed with a mediastinal tumor. The pathological diagnosis of the tumor was a bronchogenic cyst.
CONCLUSION This case further reveals the correlation between the bronchus and pericardium during embryonic development.
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Affiliation(s)
- Xiao Zhu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Lei Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Zhen Tang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Fu-Bao Xing
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Xiong Gao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Wen-Bang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
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Izumoto S, Oguri N, Koyama S, Matsuura Y, Komatsu H, Asada Y, Iwakiri H. Cardiac Strangulation Due to Partial Pericardial Defect Presenting as Acute Myocardial Infarction. JACC Case Rep 2021; 3:1635-1638. [PMID: 34729518 PMCID: PMC8543160 DOI: 10.1016/j.jaccas.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
A 79-year-old man with chest pain and dyspnea underwent emergency percutaneous coronary intervention for acute myocardial infarction. However, he died 17 days later due to refractory heart failure. An autopsy revealed cardiac strangulation caused by herniation of the apical heart through a pericardial defect due to partial absence of the pericardium. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Shintaro Izumoto
- Department of Cardiovascular Medicine, Miyakonojo Medical Association Hospital, Miyakonojo, Miyazaki, Japan
- Center for Post-Graduation Clinical Training, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nobuyuki Oguri
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shohei Koyama
- Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Center for Post-Graduation Clinical Training, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yunosuke Matsuura
- Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroyuki Komatsu
- Center for Post-Graduation Clinical Training, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hironao Iwakiri
- Department of Cardiovascular Medicine, Miyakonojo Medical Association Hospital, Miyakonojo, Miyazaki, Japan
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Sergio P, Bertella E, Muri M, Zangrandi I, Ceruti P, Fumagalli F, Bosio G. Congenital absence of pericardium: two cases and a comprehensive review of the literature. BJR Case Rep 2019; 5:20180117. [PMID: 31555471 PMCID: PMC6750629 DOI: 10.1259/bjrcr.20180117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 01/20/2023] Open
Abstract
Congenital absence of pericardium (CAP) is a rare condition, generally asymptomatic or paucisymptomatic, nevertheless sporadic cases complicated by sudden death are described. CAP can be diagnosed by CT and MRI. It is classified as total or partial, and partial defects are divided into left defects and right defects. Interestingly, several articles highlight the correlation between CAP and some anatomical lung abnormalities, such as presence of lung parenchyma between the main pulmonary artery and ascending aorta, lung parenchyma between the base of the heart and left hemidiaphragm, and lung parenchyma between the proximal ascending aorta and right pulmonary artery.
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Hoey ETD, Shahid M, Watkin RW. Computed tomography and magnetic resonance imaging evaluation of pericardial disease. Quant Imaging Med Surg 2016; 6:274-84. [PMID: 27429911 DOI: 10.21037/qims.2016.01.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pericardial diseases are commonly encountered in clinical practice and may present as an isolated process or in association with various systemic conditions. Traditionally transthoracic echocardiography (TTE) has been the method of choice for the evaluation of suspected pericardial disease but increasingly computed tomography (CT) and magnetic resonance imaging (MRI) are also being used as part of a rational multi-modality imaging approach tailored to the specific clinical scenario. This paper reviews the role of CT and MRI across the spectrum of pericardial diseases.
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Affiliation(s)
- Edward T D Hoey
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - Muhammad Shahid
- Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Richard W Watkin
- Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
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Sugiura Y, Matsusaka Y, Nemoto E, Hashizume T, Kaseda S. Incidental finding of congenital pericardial and mediastinal pleural defect by pneumothorax in an adult. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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