By Martin J. Lipton, Lawrence M. Boxt
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Extra info for Radiologic Clinics Of North America Cardiac Imaging
Gadolinium-enhanced MR imaging is a simple, accurate, and noninvasive method for detecting a leak, which necessitates urgent repeat surgery. An example of such perigraft leak is shown in Fig. 11. Nguyen and Nguyen  have reported on the plain film findings with foreign bodies in the pericardial sac. They report two cases of gunshot wounds of the chest, in each of which a bullet was retained in the pericardial sac. Because the bullets appear to be out of focus, one may think they are in the cardiac chambers, but the images of bullets retained in the pericardial sac may also be blurred because of the spinning effect of the heartbeat on the bullet.
Because of discrepancies in predicting resectability by imaging techniques (CT and MR imaging) compared with actual intraoperative findings Loscertales et al  in 2002 reported on how they perform systematic exploratory videothoracoscopy as the first step in the surgical evaluation of patients with lung cancer. The authors  claim that resectability of centrally located primary tumors with intrapericardial extension (clinical T4) can only be established by direct examination of the pericardial sac contents.
The heart is compressed between the sternum and the spine and causes the left atrial appendage to pop out. Prominence of the left atrial appendage can also be seen when the appendage herniates through a partial absence of left pericardium  or through a localized cardiac defect secondary to previous cardiac surgery. Left atrial aneurysms also can be detected on a plain film [59,60], because chest radiography can give a hint of the diagnosis with a bulky mass of soft tissue density appearing adjacent to the left atrial appendage.
Radiologic Clinics Of North America Cardiac Imaging by Martin J. Lipton, Lawrence M. Boxt