Upper left lung cancer with congenital complete left pericardial defect: A case report / 中国胸心血管外科临床杂志

@#A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.

Congenital Partial Left Pericardial Defect

Congenital pericardial defect is relatively rare and two different types, partial and complete, of different clinical significance have been recognized. Most reported defects are complete type and left-sided lesion. Most patients are asymptomatic or complain of vague chest pain. Partial pericardial defect can be potentially fatal due to cardiac herniation and strangulation or coronary insufficiency. Plain chest reontgenography shows abnormal prominence along the cardiac border. 2-D echocardiography demonstrates a drop-off of pericardial echo and protruding cardiac chamber through the defect. Because of the potential fatality, surgical repair is recommended for the partial pericardial defect. We report a case of congenital partial left pericardial defect, which was diagnosed by plain chest reontgenography and 2-D echocardiography, with related literatures.

A Case of Congenital Pericardial Defect

Congenital absence of the pericardium is thought to be uncommon. There are two types, complete and partial, of different clinical features. Complete type is innocuous but partial type is potentially fatal due to herniation. This case was referred for an unusual appearance of chest radiograph taken after admissio n for bronchopneumoia without any cardiac symptoms. Plain chest radiograph showed an unusual bulging on the left inferior cardiac boarder. The diagnosis was made on the characteristic findings as a partial defect of right side pencardium in the cardiac gated cinemagnetic resonance imaging study. We presented a case of pericardial defect with brief review of the related literatures.