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Congenital total absence of pericardium in a patient with left lung lower lobe bronchiectasis.

A 32-year-old man was referred to our clinic for surgical treatment of left lower lobe bronchiectasis. His major complaint was productive cough with sputum and frequent respiratory tract infection. He was also complaining about atypical chest pain, which had no relation with exercise or posture. On physical examination, his apical impulse was displaced to the left and pulmonary sounds were decreased in the left lower zone with some bronchial rales. Examination of the other systems was unremarkable. The preoperative laboratory parameters were in normal range. The preoperative electrocardiogram (ECG) showed incomplete right bundle branch block and nonspecific T-wave changes (Fig. 1). In chest X-ray, the heart was displaced to the left with the prominence of the pulmonary artery. The bronchiectatic lung tissue of the left lower lobe superposing on the heart shadow was seen. The contour of the left hemi-diaphragma was disappeared because of the position of the heart and the left lung (Fig. 2). Thoracic computed tomography showed left lower lobe bronchiectasis and compensatory hypertrophic right lung with cardiac displacement to the left (Fig. 3). Additionally, a part of lung tissue inserted between the ascending aorta and the main pulmonary artery was seen (Fig. 4). The echocardiography performed preoperatively had been reported to have right ventricular enlargement and mild pulmonary insufficiency. The patient underwent a left posterolateral thoracotomy for left lower lobectomy of the lung. The total agenesis of the pericardium was seen during operation (Fig. 5, 6). Heart and the other structures seemed to be normal except the macroscopic findings of the left lower lobe