Congenital absence of the left pericardium presenting as cardiogenic shock: a case report

Congenital absence of the pericardium is a rare and often incidental finding, but it may present with severe cardiovascular compromise in exceptional situations.

A 65-year-old man presented with cardiogenic shock associated with diffuse ST-segment elevation on electrocardiogram and severe metabolic acidosis. Computed tomography imaging excluded aortic dissection but revealed marked cardiac levorotation suggestive of left pericardial agenesis. Given ongoing haemodynamic instability, the patient underwent emergency surgery, which confirmed the complete absence of the left pericardium. The heart was repositioned, and a heterologous pericardial patch was placed. Postoperatively, the patient gradually recovered, requiring short-term renal replacement therapy, and was discharged to rehabilitation.

This case highlights a rare but life-threatening presentation of congenital pericardial agenesis. Early recognition and urgent surgical intervention were key to restoring haemodynamic stability. Clinicians should consider this diagnosis when encountering unexplained cardiac displacement or shock, as timely surgical repair can be lifesaving.