We present a case of a 56-year-old white male with a medical history of hypertension,who initially presented with chest pain, diaphoresis, and electrocardiogram (ECG) changes suggesting myocardial infarction. Initial frontal radiograph showed marked displacement of the cardiac silhouette into the left hemithorax. Cardiac catheterization was performed per hospital protocol showing no evidence of cardiac or coronary disease, but demonstrated marked rotation of the heart and abnormal displacement of the heart into the left hemithorax. As both of these findings could not explain the patient's symptoms, computerized tomography angiography (CTA) of the chest was performed demonstrating congenital absence of the pericardium, a rare entity estimated to occur in one in 10,000 to 14,000 people.
