Tariq Saad, Mahmood Sultan, Madeira Samuel, Tarasov Ethan
Department of Internal Medicine, St Francis Medical Center, Trenton, New Jersey, USA.
Heart Views. 2013 Jan;14(1):29-32. doi: 10.4103/1995-705X.107118.
Congenital absence of the pericardium is a rare cardiac condition, which can be either isolated or associated with other cardiac and extracardiac anomalies. There are six different types, depending on the severity of the involvement. Most of the patients with this defect are asymptomatic, especially the ones with complete absence of the pericardium. However, some patients are symptomatic, reporting symptoms that include chest pain, palpitations, dyspnea, and syncope. Diagnosis is established by the characteristic features on chest X-ray, echocardiogram, chest computed tomography (CT), and/or cardiac magnetic resonance imging (MRI). We present here a case of a 23 year-old-male, who presented to our hospital with complaints of pleuritic chest pain and exertional dyspnea, of a two-week duration. He was physically active and his past history was otherwise insignificant. His chest CT with contrast was interpreted as showing evidence of multiple emboli, predominantly in the left lung, and he was started on a heparin and warfarin therapy. A repeat chest CT with contrast three weeks later showed no significant change from the previous CT scan. Both scans showed that the heart was abnormally rotated to the left side of the chest. An echocardiogram raised the suspicion of congenital absence of the pericardium, with a posteriorly displaced heart. In retrospect, motion artifact on the left lung, attributed to cardiac pulsations and the lack of pericardium, resulted in a CT chest appearance, mimicking findings of pulmonary embolism. The misdiagnosis of pulmonary embolism was attributed to the artifact caused by excessive cardiac motion artifact on the chest CT scan. In non-gated CT angiograms, excessive motion causes an artifact that blurs the pulmonary vessels, reminiscent of a 'seagull' or a 'boomerang'. Physicians need to be aware of this phenomenon, as well as the characteristic radiological features of this congenital anomaly, to enable them to make a correct diagnosis.
先天性心包缺如是一种罕见的心脏疾病，可为孤立性，也可与其他心脏及心脏外异常相关。根据受累程度不同，可分为六种不同类型。大多数患有这种缺陷的患者无症状，尤其是那些心包完全缺失的患者。然而，一些患者有症状，表现为胸痛、心悸、呼吸困难和晕厥。通过胸部X线、超声心动图、胸部计算机断层扫描（CT）和/或心脏磁共振成像（MRI）的特征性表现来确诊。我们在此报告一例23岁男性患者，因胸膜炎性胸痛和劳力性呼吸困难持续两周前来我院就诊。他平时身体活动良好，既往史无其他重要异常。他的增强胸部CT显示有多处栓子迹象，主要在左肺，于是开始接受肝素和华法林治疗。三周后复查的增强胸部CT与前次扫描相比无明显变化。两次扫描均显示心脏异常向左胸侧旋转。超声心动图怀疑为先天性心包缺失，心脏向后移位。回顾来看，左肺上因心脏搏动和心包缺失导致的运动伪影，造成了胸部CT表现，酷似肺栓塞的表现。肺栓塞的误诊归因于胸部CT扫描时过度的心脏运动伪影所致的伪像。在非门控CT血管造影中，过度运动导致一种使肺血管模糊的伪像，类似“海鸥”或“回飞镖”。医生需要了解这种现象以及这种先天性异常的特征性放射学表现，以便能够做出正确诊断。
