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INTRODUCTION CONGENITAL PERICARDIAL defects, believed to be rare, have seldom been recognized clinically. Since the first description of this anomaly by Columbus,1 as early as 1559, we have found that 112 instances of this anomaly were published in medical literature. The diagnosis was nearly always made post mortem, even though much attention has been directed towards the importance of recognizing the condition during life.4,5,7-10The purpose of this paper is to describe a case of congenital pericardial defect. Herniation of left atrial appendage appeared as a prominent pulmonary segment on plain x-ray examination and showed active pulsations paradoxical to those in the aorta and pulmonary artery. There was a coincidental patent ductus arteriosus. REPORT OF A CASE AC, a 9-year-old white boy, was admitted to the Good Samaritan Hospital of Dayton, Ohio, for the evaluation of a cardiac murmur, noted by his physician a year prior to admission.

The early diagnosis of hydatid cysts of the heart is important because solitary cysts tend to rupture and cause a wide range of complications. Whereas previously the condition could not be treated (Better, Griffel and Brandstaetter, 1963; Dévé, 1901; 1915; 1917; 1928; 1946; 1949; Dighiero, Canabel, Aguirre, Hazan and Horjales, 1958; Grulee, 1905; Hynd, 1924; Kean and Breslau, 1964; Popo and Saviec, 1962; Romanoff and Milwidsky, 1962), progress in cardiothoracic surgery has made it possible to operate successfully on affected individuals.At the Tel-Hashomer Hospital we have encountered three cases of cardiac echinococcosis during the five-year period 1962–67. Two of the cases died. In the third, early diagnosis was made with the aid of cardioangiography and the patient was operated on successfully with a satisfactory two-year followup. This case is reported here.A 17-year-old male, born in Iraq, was first admitted to the hospital in 1961 with severe abdominal pain and extreme weakness. Physical examination did not reveal any abnormal findings. The radiograph of the chest showed normal pulmonary vasculature, enlargement of the heart and a prominent elongated left heart border with a bulge below the pulmonary segment (Fig. la). The ECG showed deep Q waves and inverted T waves in leads I, aVL, V5and V6. A tentative diagnosis of cardiomyopathy was made and the patient was discharged from hospital.

The early diagnosis of hydatid cysts of the heart is important because solitary cysts tend to rupture and cause a wide range of complications. Whereas previously the condition could not be treated (Better, Griffel and Brandstaetter, 1963; Dévé, 1901; 1915; 1917; 1928; 1946; 1949; Dighiero, Canabel, Aguirre, Hazan and Horjales, 1958; Grulee, 1905; Hynd, 1924; Kean and Breslau, 1964; Popo and Saviec, 1962; Romanoff and Milwidsky, 1962), progress in cardiothoracic surgery has made it possible to operate successfully on affected individuals.At the Tel-Hashomer Hospital we have encountered three cases of cardiac echinococcosis during the five-year period 1962–67. Two of the cases died. In the third, early diagnosis was made with the aid of cardioangiography and the patient was operated on successfully with a satisfactory two-year followup. This case is reported here.A 17-year-old male, born in Iraq, was first admitted to the hospital in 1961 with severe abdominal pain and extreme weakness. Physical examination did not reveal any abnormal findings. The radiograph of the chest showed normal pulmonary vasculature, enlargement of the heart and a prominent elongated left heart border with a bulge below the pulmonary segment (Fig. la). The ECG showed deep Q waves and inverted T waves in leads I, aVL, V5and V6. A tentative diagnosis of cardiomyopathy was made and the patient was discharged from hospital.