Left upper lobectomy in a patient with congenital pericardial defect

Congenital pericardial defect is an uncommon anomaly due to the congenital absence of the pericardium. In this case, it was associated with diaphragmatic hernia and incidentally discovered during thoracoscopic left upper lobectomy for lung cancer. The thoracoscopic dissection of the hilar structures was complicated with arrhythmia and hypotension. Thus, we converted thoracoscopy to thoracotomy, and the lobectomy was successfully performed. The pericardial defect and diaphragmatic hernia were not repaired, but the vessels and bronchial stump were covered to avoid heart injury. Postoperative course was unremarkable and at six-month follow-up patient did not have any problems.