Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1995 Jul;74(1):60–66. doi: 10.1136/hrt.74.1.60

Diagnosis of congenital pericardial defects, including a pathognomic sign for dangerous apical ventricular herniation, on magnetic resonance imaging.

I Gassner 1, W Judmaier 1, C Fink 1, M Lener 1, F Waldenberger 1, H Scharfetter 1, I Hammerer 1
PMCID: PMC483948  PMID: 7662456

Abstract

OBJECTIVE--To establish criteria for the accurate diagnosis of different forms of left sided pericardial defects on magnetic resonance imaging. Early detection of a partial apical defect is essential as it is potentially fatal. DESIGN--Examination of four children with congenital pericardial defects by magnetic resonance imaging, the results being compared with the features on conventional chest radiography and echocardiography and with published data. RESULTS--Magnetic resonance imaging improved the ability to diagnose and distinguish between complete and partial left sided pericardial defects. A deep myocardial crease was visualised in a patient with apical pericardial defect, indicating the risk of a life threatening ventricular strangulation. A prominent left atrial appendage was, in contrast to many reports, not a reliable sign for partial left sided pericardial defect. CONCLUSIONS--The various forms of congenital left sided pericardial defects cannot reliably be diagnosed in plain chest radiographs or on echocardiography. Their diagnosis and the distinction between partial and complete defects, however, is of clinical importance and can be accomplished more confidently by magnetic resonance imaging.

Full text

PDF
60

Images in this article

61Image
on p.61
62Image
on p.62
62Image
on p.62
62Image
on p.62
62Image
on p.62
63Image
on p.63
63Image
on p.63
63Image
on p.63
63Image
on p.63

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BRUNING E. G. Congenital defect of the pericardium. J Clin Pathol. 1962 Mar;15:133–135. doi: 10.1136/jcp.15.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Baim R. S., MacDonald I. L., Wise D. J., Lenkei S. C. Computed tomography of absent left pericardium. Radiology. 1980 Apr;135(1):127–128. doi: 10.1148/radiology.135.1.7360949. [DOI] [PubMed] [Google Scholar]
  3. Chaurasia B. D. Congenital pericardial defects. Teratology. 1973 Aug;8(1):55–58. doi: 10.1002/tera.1420080108. [DOI] [PubMed] [Google Scholar]
  4. Dadds V., Masters P. L. Strangulation of the left ventricle following herniation through a congenital defect in the pericardial sac. Aust Paediatr J. 1972 Apr;8(2):98–101. doi: 10.1111/j.1440-1754.1972.tb01797.x. [DOI] [PubMed] [Google Scholar]
  5. ELLIS K., LEEDS N. E., HIMMELSTEIN A. Congenital deficiencies in the parietal pericardium: a review with 2 new cases including successful diagnosis by plain roentgenography. Am J Roentgenol Radium Ther Nucl Med. 1959 Jul;82(1):125–137. [PubMed] [Google Scholar]
  6. Glover L. B., Barcia A., Reeves T. J. Congenital absence of the pericardium. A review of the literature with demonstration of a previously unreported fluoroscopic finding. Am J Roentgenol Radium Ther Nucl Med. 1969 Jul;106(3):542–549. [PubMed] [Google Scholar]
  7. Gutierrez F. R., Shackelford G. D., McKnight R. C., Levitt R. G., Hartmann A. Diagnosis of congenital absence of left pericardium by MR imaging. J Comput Assist Tomogr. 1985 May-Jun;9(3):551–553. doi: 10.1097/00004728-198505000-00026. [DOI] [PubMed] [Google Scholar]
  8. HERING A. C., WILSON J. S., BALL R. E., Jr Congenital deficiency of the pericardium. J Thorac Cardiovasc Surg. 1960 Jul;40:49–55. [PubMed] [Google Scholar]
  9. Jones J. W., McManus B. M. Fatal cardiac strangulation by congenital partial pericardial defect. Am Heart J. 1984 Jan;107(1):183–185. doi: 10.1016/0002-8703(84)90160-1. [DOI] [PubMed] [Google Scholar]
  10. Lajos T. Z., Bunnell I. L., Colokathis B. P., Schimert G. Coronary artery insufficiency secondary to congenital pericardial defect. Chest. 1970 Jul;58(1):73–76. doi: 10.1378/chest.58.1.73. [DOI] [PubMed] [Google Scholar]
  11. McMurdo K. K., Webb W. R., von Schulthess G. K., Gamsu G. Magnetic resonance imaging of the superior pericardial recesses. AJR Am J Roentgenol. 1985 Nov;145(5):985–988. doi: 10.2214/ajr.145.5.985. [DOI] [PubMed] [Google Scholar]
  12. Millaire A., Goullard L., Tison E., Rémy-Jardin M., Santré C., Ducloux G. L'agénésie unilatérale gauche du péricarde. Apport de l'imagerie cardiaque. Arch Mal Coeur Vaiss. 1990 Feb;83(2):275–280. [PubMed] [Google Scholar]
  13. Moncada R., Baker M., Salinas M., Demos T. C., Churchill R., Love L., Reynes C., Hale D., Cardoso M., Pifarre R. Diagnostic role of computed tomography in pericardial heart disease: congenital defects, thickening, neoplasms, and effusions. Am Heart J. 1982 Feb;103(2):263–282. doi: 10.1016/0002-8703(82)90499-9. [DOI] [PubMed] [Google Scholar]
  14. Nasser W. K., Helmen C., Tavel M. E., Feigenbaum H., Fisch C. Congenital absence of the left pericardium. Clinical, electrocardiographic, radiographic, hemodynamic, and angiographic findings in six cases. Circulation. 1970 Mar;41(3):469–478. doi: 10.1161/01.cir.41.3.469. [DOI] [PubMed] [Google Scholar]
  15. Nicolosi G. L., Borgioni L., Alberti E., Burelli C., Maffesanti M., Marino P., Slavich G., Zanuttini D. M-mode and two-dimensional echocardiography in congenital absence of the pericardium. Chest. 1982 May;81(5):610–613. doi: 10.1378/chest.81.5.610. [DOI] [PubMed] [Google Scholar]
  16. Payvandi M. N., Kerber R. E. Echocardiography in congenital and acquired absence of the pericardium. An echocardiographic mimic of right ventricular volume overload. Circulation. 1976 Jan;53(1):86–92. doi: 10.1161/01.cir.53.1.86. [DOI] [PubMed] [Google Scholar]
  17. Pernot C., Hoeffel J. C., Henry M., Frisch R., Brauer B. Partial left pericardial defect with herniation of the left atrial appendage. Thorax. 1972 Mar;27(2):246–250. doi: 10.1136/thx.27.2.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Robin E., Ganguly S. N., Fowler M. S. Strangulation of the left atrial appendage through a congenital partial pericardial defect. Chest. 1975 Mar;67(3):354–355. doi: 10.1378/chest.67.3.354. [DOI] [PubMed] [Google Scholar]
  19. Rogge J. D., Mishkin M. E., Genovese P. D. Congenital partial pericardial defect with herniation of the left atrial appendage. Ann Intern Med. 1966 Jan;64(1):137–141. doi: 10.7326/0003-4819-64-1-137. [DOI] [PubMed] [Google Scholar]
  20. Rowland T. W., Twible E. A., Norwood W. I., Jr, Keane J. F. Partial absence of the left pericardium. Diagnosis by two-dimensional echocardiography. Am J Dis Child. 1982 Jul;136(7):628–630. doi: 10.1001/archpedi.1982.03970430060017. [DOI] [PubMed] [Google Scholar]
  21. Saito R., Hotta F. Congenital pericardial defect associated with cardiac incarceration: case report. Am Heart J. 1980 Dec;100(6 Pt 1):866–870. doi: 10.1016/0002-8703(80)90068-x. [DOI] [PubMed] [Google Scholar]
  22. Salem D. N., Hymanson A. S., Isner J. M., Bankoff M. S., Konstam M. A. Congenital pericardial defect diagnosed by computed tomography. Cathet Cardiovasc Diagn. 1985;11(1):75–79. doi: 10.1002/ccd.1810110111. [DOI] [PubMed] [Google Scholar]
  23. Schiavone W. A., O'Donnell J. K. Congenital absence of the left portion of parietal pericardium demonstrated by nuclear magnetic resonance imaging. Am J Cardiol. 1985 May 1;55(11):1439–1440. doi: 10.1016/0002-9149(85)90528-4. [DOI] [PubMed] [Google Scholar]
  24. Sechtem U., Tscholakoff D., Higgins C. B. MRI of the normal pericardium. AJR Am J Roentgenol. 1986 Aug;147(2):239–244. doi: 10.2214/ajr.147.2.239. [DOI] [PubMed] [Google Scholar]
  25. Sunderland S., Wright-Smith R. J. CONGENITAL PERICARDIAL DEFECTS. Br Heart J. 1944 Oct;6(4):167–175. doi: 10.1136/hrt.6.4.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. von Bernuth G., Nissen H., Lang D., Hofstetter R. Kongenitale Defekte des linksseitigen Perikards. Z Kardiol. 1976 Nov;65(11):1022–1032. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES