Congenital absence of the left pericardium.

CASE HISTORY A 20-year-old female sought advice for diarrhoea and vomiting which followed a holiday in Majorca. She had no other symptoms. Apart from investigation of a cardiac murmur when she was six, past medical history was unremarkable. On examination she appeared healthy, with no fever or dehydration. Her abdomen was normal. Pulse was 100/min, regular, and blood pressure 110/60. Her apex beat was not displaced and of normal character. On auscultation there was wide but variable splitting of the second sound with a loud pulmonary component, and a grade 3/6 mid-systolic murmur heard in the pulmonary area only. Her first heart sound was normal and no other murmurs or bruits were heard. Electrocardiograph (Fig 1) showed right axis deviation and clockwise rotation. Chest X ray (Fig 2) showed an abnormal cardiac outline, consistent with leftward rotation. The trachea was central, and lung fields and pulmonary vascularity