Pendulous Heart with Alternating Axis: A Suspicious Clue for Diagnosis of a Rare Disease

Absence of pericardium is a rare type of pericardial disorders. Left sided pericardial absence is more common than the right one. This disorder may present with a variety of signs and symptoms or abnormalities in electrocardiography and echocardiography. In this report, we discussed diagnosis of partial absence of pericardium in a 52-year-old man presented with a dull left-sided chest pain from 4 months ago with special electrocardiographic features. The axis deviations in his serial electrocardiograms led us to further evaluations with possible diagnosis of pericardial absence. His echocardiography and Magnetic Resonance Imaging (MRI) confirmed the suspicion of pericardial absence. Suspicion of potentially life-threatening cardiac abnormalities should remain even while facing atypical chest pain or other non-specific symptoms. In this case, abnormal electrocardiographic and chest X-Ray findings together with echocardiography were all helpful in referring the patient for cardiac MRI as the imaging modality of choice in such cases.