Case report
Congenital complete absence of pericardium in a young woman with non-specific symptoms
Ausência congénita completa do pericárdio numa mulher jovem com sintomatologia não específica
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0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1006 "Ancho" => 1584 "Tamanyo" => 129184 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Comunicação interventricular (CIV) subvalvular ao nível do plano dos folhetos da válvula mitral (Val. Mi.) e válvula tricúspide (Val. Tri.) – (janela paraesternal eixo curto).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Anne Delgado, Davide Moreira, Bruno Marmelo, Miguel Correia, Emanuel Correia, Oliveira Santos" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Anne" "apellidos" => "Delgado" ] 1 => array:2 [ "nombre" => "Davide" "apellidos" => "Moreira" ] 2 => array:2 [ "nombre" => "Bruno" "apellidos" => "Marmelo" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Correia" ] 4 => array:2 [ "nombre" => "Emanuel" "apellidos" => "Correia" ] 5 => array:2 [ "nombre" => "Oliveira" "apellidos" => "Santos" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204914000981" "doi" => "10.1016/j.repce.2013.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914000981?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114000729?idApp=UINPBA00004E" "url" => "/08702551/0000003300000004/v1_201405230947/S0870255114000729/v1_201405230947/pt/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0870255114000808" "issn" => "08702551" "doi" => "10.1016/j.repc.2013.10.014" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "454" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2014;33:247.e1-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4727 "formatos" => array:3 [ "EPUB" => 199 "HTML" => 3623 "PDF" => 905 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Cardiac Anderson-Fabry disease: Lessons from a 25-year-follow up" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247.e1" "paginaFinal" => "247.e7" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Doença cardíaca de Anderson–Fabry: lições de um caso com 25 anos de seguimento" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4000 "Ancho" => 2949 "Tamanyo" => 975355 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram/Doppler imaging. Top (1998, age 45 years): long-axis view showing mild septal thickening, non-dilated and normally contracting left ventricle, and normal left atrium (A, B, C); short-axis view at the level of the mitral leaflet tips (D) and mid-cavity (E); apical 4-chamber view showing slight thickening of the lateral-apical wall (F); middle (2007, age 54 years) – normal tissue Doppler imaging at the septal (G) and lateral (H) corners of the mitral annulus; bottom (2012, age 59-years) – thickened septum (I, J, M – 20 mm); thickened lateral-apical wall (J); non-dilated and normally contracting left ventricle (M); dilated left atrium, 51 mm (L); mild mitral regurgitation (K); diastolic dysfunction and affected longitudinal systolic LV function (N, O, P – see text for details).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dulce Brito, Gabriel Miltenberger–Miltenyi, Oana Moldovan, Carmen Navarro, Hugo Costa Madeira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Dulce" "apellidos" => "Brito" ] 1 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Miltenberger–Miltenyi" ] 2 => array:2 [ "nombre" => "Oana" "apellidos" => "Moldovan" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Navarro" ] 4 => array:2 [ "nombre" => "Hugo Costa" "apellidos" => "Madeira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204914001056" "doi" => "10.1016/j.repce.2013.10.042" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001056?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114000808?idApp=UINPBA00004E" "url" => "/08702551/0000003300000004/v1_201405230947/S0870255114000808/v1_201405230947/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Congenital complete absence of pericardium in a young woman with non-specific symptoms" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "249.e1" "paginaFinal" => "249.e5" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio Bueno Palomino, Alberto Palomar Estrada, Manuel Crespín Crespín, Daniel García Fuertes" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Antonio" "apellidos" => "Bueno Palomino" "email" => array:1 [ 0 => "antoniobuenopalomino@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alberto" "apellidos" => "Palomar Estrada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Manuel" "apellidos" => "Crespín Crespín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Daniel" "apellidos" => "García Fuertes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Radiology, Santa Bárbara Hospital, Puertollano, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Cardiology, Santa Bárbara Hospital, Puertollano, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ausência congénita completa do pericárdio numa mulher jovem com sintomatologia não específica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1178 "Ancho" => 2667 "Tamanyo" => 350183 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ECG showing sinus rhythm at 71 bpm, PR interval 120 ms, right axis deviation, poor R-wave progression in the precordial leads, inferolateral repolarization abnormalities and negative T wave in V5-V6, II, III and aVF (asterisk).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Congenital defects of the pericardium are rare and in most cases asymptomatic.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> They used to be diagnosed as an incidental finding during surgery or autopsy, but the more widespread use of imaging techniques has increased their incidence.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> The most common congenital anomaly is complete absence of the left pericardium, which is usually asymptomatic.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, partial defects can cause symptoms due to ventricular herniation or entrapment and may even cause sudden death, and surgical repair is needed in these cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 17-year-old woman attended in our institution for non-specific but frequent symptoms, who was diagnosed with congenital complete absence of the pericardium.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a 17-year-old female patient with no relevant medical background, cardiovascular risk factors, or family history of heart disease or sudden death. The patient was referred to the cardiology department of our institution for episodes of dizziness lasting for seconds without spinning sensation, accompanied by cold sweats. Syncope was not present on any occasion and she did not report chest pain, palpitations or dyspnea. Physical examination and vital signs were all normal (blood pressure 102/63 mmHg and heart rate 74 bpm). Lower limbs showed no edema or signs of deep vein thrombosis, and femoral and pedal pulses were preserved. Diagnostic examinations revealed the following:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0020" class="elsevierStylePara elsevierViewall">ECG: sinus rhythm at 71 bpm, PR interval 120 ms, right axis deviation, poor R-wave progression in the precordial leads, inferolateral repolarization abnormalities and negative T waves in V5–V6, II, III, and aVF (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0025" class="elsevierStylePara elsevierViewall">Chest X-ray: displacement of the cardiac silhouette to the left without tracheal deviation, obliteration of the right cardiac border overlapping the spine and imprint of the pulmonary artery (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0030" class="elsevierStylePara elsevierViewall">Blood tests: no changes in the various parameters studied.</p></li><li class="elsevierStyleListItem" id="lsti0020"><p id="par0035" class="elsevierStylePara elsevierViewall">Holter ECG recording: sinus rhythm with extreme frequencies and circadian variation within normal range; no relevant ventricular or supraventricular arrhythmias, pauses or atrioventricular block.</p></li><li class="elsevierStyleListItem" id="lsti0025"><p id="par0040" class="elsevierStylePara elsevierViewall">Echocardiogram: apex offset to the left and posteriorly, particularly noticeable in modified parasternal long-axis view. The left ventricle was non-dilated with preserved systolic function, while the right ventricle was slightly dilated, especially in apical 4-chamber view, forming the bulk of the ventricular apex. The left ventricular filling pattern was normal. The mitral valve opened correctly without a gradient, and tricuspid and aortic valve function was normal. There was mild tricuspid regurgitation with normal pulmonary artery systolic pressure. The inferior vena cava was dilated. The septum showed no alterations and the ascending aorta and aortic arch were normal. The pericardium could not be clearly identified.</p></li><li class="elsevierStyleListItem" id="lsti0030"><p id="par0045" class="elsevierStylePara elsevierViewall">Computed tomography (CT): the cardiac silhouette was displaced, with the apex in left posterior position. The parietal pericardium could not be identified between epicardial and mediastinal fat (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0035"><p id="par0050" class="elsevierStylePara elsevierViewall">Cardiac magnetic resonance (CMR): the left heart was displaced, with flattening of the septum and the apex located posteriorly, pulmonary trunk protruding towards the left lung and interposition of pulmonary parenchyma between the diaphragm, descending aorta and diaphragmatic surface of the heart. Epicardial fat was in direct contact with the mediastinal pleura and the recess between the ascending aorta and pulmonary trunk was occupied by mediastinal fat. The pericardium could not be observed in any of the sequences (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">All these findings were consistent with the diagnosis of complete pericardial agenesis, so we opted for clinical monitoring in outpatient cardiological consultations. The patient is asymptomatic at the present time.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Congenital absence of the pericardium (CAP) is a rare entity that is difficult to diagnose and is usually identified incidentally in clinical autopsies or surgical procedures performed for other reasons.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> Its pathogenesis is multifactorial, but premature atrophy of the left common cardinal vein (left duct of Cuvier) during the 5th and 6th week of embryonic life compromises the blood supply to the left pleuropericardial fold, preventing it from closing normally.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Its prevalence is approximately 0.002–0.004% in surgical and pathological series.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7</span></a> It is three times more common in males and other congenital anomalies may be associated in 30–50% of cases, the most common being patent ductus arteriosus, atrial septal defect, mitral valve stenosis, bronchogenic cyst, tetralogy of Fallot, pulmonary sequestration, diaphragmatic hernia and pectus excavatum.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,8</span></a> CAP may also be found as a part of other disorders such as VATER association or Marfan or Pallister-Killian syndromes.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Six types of CAP have been described, including total absence, right-sided defects (complete or partial), left-sided defects (complete or partial), and diaphragmatic defects.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8</span></a> The most common is complete left pericardial defect (70%), while right-sided agenesis is found in 4%, diaphragmatic defects in 17% and total absence in 9%.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Diaphragmatic pericardial agenesis is usually associated with absence of the left hemidiaphragm, in which there is a direct communication from the abdominal viscera to the heart. In 75% of cases of partial left agenesis there may also be a defect in the parietal pleura, resulting in herniation of lung parenchyma surrounding the adjacent vascular structures.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">CAP is usually asymptomatic, especially in complete absence of the pericardium.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,9</span></a> However, non-specific chest pain, dyspnea, recurrent pulmonary infections, fatigue, angina, heart failure, pericarditis, arrhythmias, peripheral embolism, syncope and even sudden death have been reported.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Diagnosis is often difficult because the physical examination is usually non-specific, but it may reveal a significantly displaced apical impulse, basal ejection murmurs, apical mid-systolic clicks and increased splitting of the second heart sound due to right bundle branch block.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,10,8,11,12</span></a> The ECG may be normal in small or partial defects, with sinus bradycardia induced by vagal stimulation the only finding. In other cases the ECG may show typical findings such as right axis deviation, incomplete or complete right bundle branch block and poor R-wave progression due to clockwise rotation in the horizontal plane. Abnormalities of the ST segment and T wave are rare.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–7</span></a> Chest X-ray findings suggestive of CAP include prominence of the main pulmonary artery, levoposition of the heart without tracheal deviation (which may be mistaken for cardiomegaly), absence of the right heart border because it is superimposed on the spine, and flattening and elongation of the left ventricular contour (Snoopy sign).<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–8</span></a> As in our case, the echocardiogram may be helpful for the initial evaluation of CAP, with features related to abnormal cardiac position and movement: unusual echocardiographic windows, cardiac hypermobility, ‘teardrop’ appearance, paradoxical or flat systolic motion of the interventricular septum, severe tricuspid regurgitation and right ventricular dilatation. However, echocardiography is usually less useful in partial defects.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">CT can reveal the abnormal rotation and displacement of the heart and it may also show absence of the parietal pericardium as direct contact between mediastinal and epicardial fat. Nevertheless, absence of pericardium is difficult to identify in left-sided or posterior defects, due to the smaller quantity of fat in this location, which is the main limitation of this imaging modality.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">CMR is considered the gold standard imaging technique due to its better soft tissue definition using spin-echo sequences synchronized with the cardiac cycle and its ability to detect focal myocardial infarctions.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,14</span></a> When the pericardium is not visualized directly, there may be indirect CMR signs that distinguish between partial left agenesis (prominence of the main pulmonary artery with normal heart position) and total left agenesis (levoposition of the heart, contact between the left atrium and descending aorta, and the preaortic recess filled with mediastinal fat). In addition, CMR can diagnose cardiac herniation due to a partial defect; annular constriction of the apical ventricular myocardium is the most common cause of death in these patients.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–18</span></a> Treatment is not required in total agenesis or complete unilateral agenesis,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,6,10,8,11,12</span></a> although one case has been reported in which a complete left-sided defect required surgical correction to alleviate symptoms.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Partial defects should be surgically repaired in symptomatic patients and in asymptomatic patients with signs of ventricular strangulation diagnosed by an imaging technique.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> There is controversy concerning asymptomatic patients with atrial herniation, since no cases of sudden death have been reported for this reason.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,15</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion, CAP is an unusual anomaly and usually asymptomatic. Nevertheless, it is important to diagnose and characterize this entity accurately due to the risk of complications and sudden death in patients with partial defects. Surgical treatment is reserved for symptomatic patients and in asymptomatic patients at risk for ventricular entrapment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres341195" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec322959" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres341194" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec322960" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-28" "fechaAceptado" => "2013-10-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec322959" "palabras" => array:5 [ 0 => "Pericardium" 1 => "Absence" 2 => "Multislice computed tomography" 3 => "Magnetic resonance" 4 => "Image" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec322960" "palabras" => array:5 [ 0 => "Pericárdio" 1 => "Ausência" 2 => "Tomografia computadorizada de múltiplos detectores" 3 => "Ressonância magnética" 4 => "Imagem" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Congenital absence of the pericardium is a very rare entity that is usually asymptomatic and hence difficult to diagnose. However, cases of sudden death have been reported in patients with partial pericardial defects (even asymptomatic ones), and such patients require surgical treatment.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report the case of a 17-year-old patient with complete pericardial agenesis (diagnosed by chance during a cardiological consultation) and briefly review the radiological findings of this entity.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Agenesia congénita do pericárdio é uma entidade muito rara e de difícil diagnóstico, pois na maioria dos casos é geralmente assintomática. No entanto, tem havido relatos de morte súbita em pacientes com agenesia do pericárdio parcial, sendo necessário nestas situações a cirurgia (mesmo em pacientes assintomáticos).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Os objetivos deste trabalho são apresentar o caso de uma paciente de 17 anos com agenesia do pericárdio completo (diagnosticadas por acaso, durante uma visita ao cardiologista) e uma breve revisão dos achados radiológicos desta entidade.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1178 "Ancho" => 2667 "Tamanyo" => 350183 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ECG showing sinus rhythm at 71 bpm, PR interval 120 ms, right axis deviation, poor R-wave progression in the precordial leads, inferolateral repolarization abnormalities and negative T wave in V5-V6, II, III and aVF (asterisk).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1228 "Ancho" => 1500 "Tamanyo" => 108573 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Posterior–anterior chest X-ray showing levoposition of the heart without tracheal deviation, right heart border superimposed on the spine (straight arrow), imprint of the main pulmonary artery (curved arrow), interposition of lung parenchyma between the aortic arch and left pulmonary artery (asterisk) and flattening and elongation of the left ventricular contour (Snoopy sign).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 746 "Ancho" => 900 "Tamanyo" => 70775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Axial non-enhanced chest computed tomography showing displacement of the heart with the apex in left posterior position. Parietal pericardium cannot be observed between epicardial and mediastinal fat.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1617 "Ancho" => 2333 "Tamanyo" => 326593 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">(A and B) ECG-gated cine gradient echo sequences, transverse plane. Left posterolateral rotation and displacement of the heart with flattening of the septum and apex in posterior location. Epicardial fat is in direct contact with the mediastinal pleura. The recess between the ascending aorta and the root of the pulmonary artery is filled with mediastinal fat (arrow); (C) ECG-gated cine gradient echo sequences, coronal plane, showing levoposition of the heart with apex in posterior location (curved arrow), protrusion of the left pulmonary artery root (straight arrow) and interposition of lung parenchyma between the diaphragm, descending aorta and diaphragmatic surface of the heart (asterisk). The pericardium cannot be observed in any sequence.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Agenesia de pericardio. Comunicación de un caso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.C. Caniggia" 1 => "E. Gabe" 2 => "E. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 7 | 14 |
| 2024 Outubro | 57 | 34 | 91 |
| 2024 Setembro | 67 | 25 | 92 |
| 2024 Agosto | 73 | 32 | 105 |
| 2024 Julho | 53 | 36 | 89 |
| 2024 Junho | 45 | 22 | 67 |
| 2024 Maio | 49 | 21 | 70 |
| 2024 Abril | 50 | 28 | 78 |
| 2024 Maro | 48 | 23 | 71 |
| 2024 Fevereiro | 62 | 38 | 100 |
| 2024 Janeiro | 42 | 33 | 75 |
| 2023 Dezembro | 61 | 23 | 84 |
| 2023 Novembro | 71 | 30 | 101 |
| 2023 Outubro | 37 | 14 | 51 |
| 2023 Setembro | 31 | 29 | 60 |
| 2023 Agosto | 43 | 29 | 72 |
| 2023 Julho | 36 | 11 | 47 |
| 2023 Junho | 35 | 16 | 51 |
| 2023 Maio | 65 | 21 | 86 |
| 2023 Abril | 33 | 6 | 39 |
| 2023 Maro | 40 | 20 | 60 |
| 2023 Fevereiro | 47 | 26 | 73 |
| 2023 Janeiro | 37 | 24 | 61 |
| 2022 Dezembro | 56 | 30 | 86 |
| 2022 Novembro | 53 | 25 | 78 |
| 2022 Outubro | 55 | 16 | 71 |
| 2022 Setembro | 31 | 31 | 62 |
| 2022 Agosto | 40 | 40 | 80 |
| 2022 Julho | 50 | 31 | 81 |
| 2022 Junho | 37 | 21 | 58 |
| 2022 Maio | 41 | 35 | 76 |
| 2022 Abril | 44 | 24 | 68 |
| 2022 Maro | 31 | 35 | 66 |
| 2022 Fevereiro | 34 | 22 | 56 |
| 2022 Janeiro | 34 | 25 | 59 |
| 2021 Dezembro | 27 | 31 | 58 |
| 2021 Novembro | 41 | 37 | 78 |
| 2021 Outubro | 51 | 46 | 97 |
| 2021 Setembro | 40 | 25 | 65 |
| 2021 Agosto | 52 | 41 | 93 |
| 2021 Julho | 31 | 36 | 67 |
| 2021 Junho | 47 | 25 | 72 |
| 2021 Maio | 35 | 37 | 72 |
| 2021 Abril | 67 | 38 | 105 |
| 2021 Maro | 90 | 12 | 102 |
| 2021 Fevereiro | 76 | 13 | 89 |
| 2021 Janeiro | 54 | 15 | 69 |
| 2020 Dezembro | 56 | 9 | 65 |
| 2020 Novembro | 51 | 14 | 65 |
| 2020 Outubro | 55 | 9 | 64 |
| 2020 Setembro | 73 | 25 | 98 |
| 2020 Agosto | 34 | 10 | 44 |
| 2020 Julho | 80 | 7 | 87 |
| 2020 Junho | 64 | 8 | 72 |
| 2020 Maio | 61 | 4 | 65 |
| 2020 Abril | 52 | 20 | 72 |
| 2020 Maro | 53 | 16 | 69 |
| 2020 Fevereiro | 174 | 19 | 193 |
| 2020 Janeiro | 69 | 5 | 74 |
| 2019 Dezembro | 63 | 11 | 74 |
| 2019 Novembro | 65 | 3 | 68 |
| 2019 Outubro | 49 | 9 | 58 |
| 2019 Setembro | 136 | 17 | 153 |
| 2019 Agosto | 60 | 3 | 63 |
| 2019 Julho | 61 | 15 | 76 |
| 2019 Junho | 60 | 7 | 67 |
| 2019 Maio | 75 | 12 | 87 |
| 2019 Abril | 59 | 22 | 81 |
| 2019 Maro | 73 | 11 | 84 |
| 2019 Fevereiro | 84 | 14 | 98 |
| 2019 Janeiro | 41 | 3 | 44 |
| 2018 Dezembro | 64 | 14 | 78 |
| 2018 Novembro | 182 | 9 | 191 |
| 2018 Outubro | 302 | 21 | 323 |
| 2018 Setembro | 101 | 10 | 111 |
| 2018 Agosto | 119 | 16 | 135 |
| 2018 Julho | 80 | 8 | 88 |
| 2018 Junho | 103 | 8 | 111 |
| 2018 Maio | 158 | 9 | 167 |
| 2018 Abril | 181 | 6 | 187 |
| 2018 Maro | 128 | 12 | 140 |
| 2018 Fevereiro | 85 | 2 | 87 |
| 2018 Janeiro | 125 | 7 | 132 |
| 2017 Dezembro | 155 | 7 | 162 |
| 2017 Novembro | 122 | 9 | 131 |
| 2017 Outubro | 100 | 10 | 110 |
| 2017 Setembro | 88 | 9 | 97 |
| 2017 Agosto | 109 | 15 | 124 |
| 2017 Julho | 97 | 11 | 108 |
| 2017 Junho | 52 | 10 | 62 |
| 2017 Maio | 63 | 10 | 73 |
| 2017 Abril | 40 | 4 | 44 |
| 2017 Maro | 42 | 5 | 47 |
| 2017 Fevereiro | 80 | 4 | 84 |
| 2017 Janeiro | 50 | 6 | 56 |
| 2016 Dezembro | 47 | 13 | 60 |
| 2016 Novembro | 84 | 11 | 95 |
| 2016 Outubro | 123 | 12 | 135 |
| 2016 Setembro | 202 | 17 | 219 |
| 2016 Agosto | 134 | 13 | 147 |
| 2016 Julho | 62 | 11 | 73 |
| 2016 Junho | 5 | 11 | 16 |
| 2016 Maio | 21 | 0 | 21 |
| 2016 Abril | 109 | 2 | 111 |
| 2016 Maro | 122 | 16 | 138 |
| 2016 Fevereiro | 164 | 23 | 187 |
| 2016 Janeiro | 161 | 15 | 176 |
| 2015 Dezembro | 142 | 10 | 152 |
| 2015 Novembro | 122 | 13 | 135 |
| 2015 Outubro | 274 | 13 | 287 |
| 2015 Setembro | 121 | 12 | 133 |
| 2015 Agosto | 97 | 11 | 108 |
| 2015 Julho | 171 | 15 | 186 |
| 2015 Junho | 83 | 9 | 92 |
| 2015 Maio | 106 | 11 | 117 |
| 2015 Abril | 103 | 8 | 111 |
| 2015 Maro | 122 | 3 | 125 |
| 2015 Fevereiro | 122 | 13 | 135 |
| 2015 Janeiro | 81 | 8 | 89 |
| 2014 Dezembro | 73 | 8 | 81 |
| 2014 Novembro | 77 | 15 | 92 |
| 2014 Outubro | 129 | 16 | 145 |
| 2014 Setembro | 81 | 10 | 91 |
| 2014 Agosto | 87 | 15 | 102 |
| 2014 Julho | 83 | 21 | 104 |
| 2014 Junho | 86 | 39 | 125 |
| 2014 Maio | 39 | 19 | 58 |
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