Congenital deficiency of the pericardium.

THE P A " ' PE"CAFm1"" MAY BE incompletely formed at birth, resulting in partial absence or deficiency of this membrane. As an isolated anomaly, the condition is rare. The subject was thoroughly reviewed by Ellis and assofiates' in 1959. Less than 120 validated c a m have been reported since that of Baillie' in 1793. Despite this rarity, the condition is of in-temt to the clinician and radiologist because it may simulate more serious cardiac pathology. It may be associated with defects of thoracic stmctures~ or with other forms of congenital heart disease? and it may be a cause of unusual thoracic symp toms. Prior to 1936, congenital absence of the pericardium had been recognized only at necromv. Since then. 29 c a m have been from three to 57 years and one female who was nine months old. The pericardial deficiency was associated with a ventricular septal defect in one patient and with patent ductus arteriosus in another. Two other patients had evidence of pulmonary di-ease, and three were studied b e c a w of suspected heart disease. One of these was found to have a large diaphragmatic hernia. In these five patients, no evidence of intrinsic cardiac disease was found. CASE REPORTS cAse I This patient was examined when he was 15 years old becaure of recurrent bouts of fever and hemoptysis during the preceding one and one-half yean. Bronchographic studies revealed bronchiectasb in the left upper lobe. A left up-w r lobectomv was carried out. At the time of. , diagnosed antemortem, 21 at o p operation in 1945, a large defect was noted in eration and eight by the demonstration the left side of the pericardium "through which a considerable partion of the heart could be of pneumopericardium after pneumotho-visualized." After the operation, recovery was A 57-year-old man underwent thoracotomy cases of absence of the pencar-for carcinoma of the left lung. The left side of dium are the pericardium was found to be a b w t. Thr the association of the anomaly with other right side was palpated and found to be intact. defects of thoracic structures, the eass of A left pneumonectomy was done, after which diagnosis by means of diagnostic pneumo-the heart could be rotated freely in the left side thorax, and the unique electrocardiogaph-of the chest. Atrial fibrillation appeared as a transient dysrhythmia three days after operation. ic in patients …