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Pericardial agenesis: a rare cause of chest pain
  1. Alexandros Hotouras1,
  2. Yousef Shahin2
  1. 1Derby Hospitals NHS Trust, Derby, UK
  2. 2Academic Vascular Surgery Unit, University of Hull, Hull, UK
  1. Correspondence toDr Yousef Shahin, Academic Vascular Surgery Unit, Hull Royal Infirmary, Vascular Laboratory, Alderson's House, Hull HU3 2JZ, UK; yousef.shahin{at}

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Case history

A young male patient presented with a history of indigestion-like retrosternal discomfort. He reported retrosternal tightness on exertion associated with occasional sweating, nausea and shortness of breath. He was otherwise fit and well and medication free. On examination, his pulse was regular at 60 bpm, and his blood pressure was 122/78 mm Hg. On auscultation, the second heart sound was loud.

A 12-lead ECG at rest showed sinus arrhythmia with a rate of about 75 bpm, inverted T waves in leads III, aVF and V2, poor R wave progression, and a wide QRS complex. A chest radiograph revealed left-sided cardiac displacement in the absence of any pulmonary abnormality (figure 1).

Figure 1

Chest radiograph showing left-sided cardiac displacement.

Echocardiogram windows were suboptimal. Apical windows gave images that were closer to the standard parasternal windows. A cardiac MRI scan confirmed …

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