Pericardial Agenesis: The Significance of Multimodality Imaging in Diagnosis

Pericardial agenesis is a rare pericardial defect that can be complete or partial. Often an incidental finding, most patients are asymptomatic at time of detection but some can present with symptoms of atypical chest pain, dyspnoea, palpitations or dizziness. There can be a delay in diagnosis as imaging is essential to confirm the diagnosis although there may be subtle signs on radiographic imaging and electrocardiogram. Both cardiac magnetic resonance imaging and computed tomography can be used to diagnose the condition and distinguish between complete and partial pericardial agenesis, although cardiac magnetic resonance has been suggested as the investigation of choice. Recognition of the condition is important as it poses a risk of complications, particularly in those with partial pericardial agenesis. Most asymptomatic patients with complete pericardial agenesis are managed conservatively. In this case report, we describe a case of a 45-year-old woman who presented with pleuritic chest pain and haemoptysis who was found to have complete pericardial agenesis on workup.