Total congenital absence of left pericardium in 3 cases

: Congenital absence of left pericardium is rare. We report three adult women, mean age 48 years old, in which this diagnosis was confirmed. This condition must be suspected in patients with atypical chest pain, as in 2 of our cases, or in the presence of radiologic cardiomegaly of unknown origin, as in the third case. Physical examination may disclose a left displaced cardiac apex and electrocardiogram a right axis deviation, incomplete right bundle branch block and clockwise rotation. Chest X rays show a left displaced heart with a prominent pulmonary artery and the interposition of pulmonary flap between the aorta and pulmonary artery and between left hemidiaphragm and lower cardiac border. There is an echocardiographic impression of left chamber enlargement and the usual apical, four chamber vision is observed placing the transductor in posterior positions. The diagnosis could be confirmed with computed tomography and magnetic resonance imaging.