Congenital partial pericardial defect discovered incidentally during surgery for lung cancer: a case report and literature review

Abstract

Background Congenital pericardial defects are rare congenital anomalies, often asymptomatic and incidentally detected during thoracic surgery. Case presentation A 74-year-old man with primary lung cancer (cT1cN0M0, Stage IA3) underwent thoracoscopic radical lobectomy. At the time of thoracotomy, a pericardial defect was found on the ventral side of the hilar region, and the left atrial appendage was exposed. Due to concern that contact between the bronchial stump and the left atrial appendage may lead to postoperative bleeding and heart hernia, the pericardial defect was closed with an expanded polytetrafluoroethylene GoreTex® membrane. Preoperative computed tomography was reanalyzed with a 1 mm slice, congenital pericardial defect was detected as the pericardium had penetrated under the left atrial appendage. Conclusions In congenital partial pericardial defect, contact between the left atrial appendage and bronchial stump, due to movement of the lung or heart, increases the risk of bleeding after lung resection. Therefore, closure of the defect should be considered. Although it is difficult to diagnose congenital partial pericardial defect preoperatively, computed tomography taken with a slice thickness of 1 mm is useful for diagnosis.

Left upper lobectomy in a patient with congenital pericardial defect

“…Thoracic surgeons should be aware of the association between CPD and lung cancer. In line with other reports, 2 also in this case, CPD was preoperatively misdiagnosed and incidentally detected during lobectomy. Cardiac magnetic resonance imaging (MRI) was the most appropriate exam for diagnosing CPD.…”

“…Cardiac magnetic resonance imaging (MRI) was the most appropriate exam for diagnosing CPD. 1,2 Despite preoperative chest CT scan showed leftward-shifted cardiac silhouette, we did not find it remarkable enough to make a diagnosis of CPD. Thus, cardiac MRI was not performed as it was not a routine examination for preoperative diagnosis of lung cancer.…”

“…7 In case of CPD, the heart, epicardium and the coronary artery should be protected as the movement of the organs may cause contact between the vessels and bronchial stumps and lead to perforation and bleeding. 2,3,8 As we did not reconstruct the CPD, to avoid these complications the vessel stumps were covered by fibrin glue and hemostatic agents and the bronchial stump by mediastinal pleura. Diaphragmatic hernia was not repaired as it did not limit the feasibility of performing upper lobectomy; yet the elevation of diaphragm reduced upper lobe space, sustaining the heart and preventing herniation.…”

Left pulmonary aplasia with multiloculated effusion and pericardial defects in a young adult: a case report

“…Her pleural fluid and pleural specimen were negative for Mycobacterium tuberculosis or fungal stain, so she did not receive other medications. PPD's reported in 0.01-0.04% were the incidental findings present in our case, were not intervened as cardiac function was normal; however, if symptomatic, PPDʼs are repaired with expanded polytetrafluoroethylene GoreTex surgical pericardial membrane [7].…”

A Case of Incidentally Discovered Congenital Complete Pericardial Defect during Lobectomy for Lung Cancer: A Case Report and Literature Review

“…Congenital pericardial defects are rare anomalies often first observed intraoperatively. 1) Most affected individuals are asymptomatic, and finding these defects during preoperative tests can be difficult. Complete pericardial defects are even more rarely diagnosed intraoperatively if only lobectomy or pneumonectomy is performed.…”