Left mediastinal pleural and left pericardial agenesis, diagnosis, complications and management

We present a case of 69 yrs old man with history of coronary artery disease who required coronary artery bypass graft surgery and is noted to have incidental detection of complete absence of left mediastinal pleura and left pericardium with levocardia and multiple adhesions which were dissected out and adhesions cleared. Although complete pericardial absence is rare with reported incidence of 1 in 14,000 patients, left mediastinal pleural and pericardial combined agenesis is even rare and very few cases have been reported in literature. We describe the technical difficulties, operative diagnosis and complications.