Asymptomatic adult intrapericardial diaphragmatic hernia detected on cardiac SPECT CT

An 83-year-old man underwent exercise stress test with single photon emission computed tomography (spect) myocardial perfusion imaging for new electrocardiogram (ekg) changes. the stress ekg did not show any significant changes. myocardial perfusion imaging with spect demonstrated an inferior wall defect and extracardiac uptake of nuclear tracer. simultaneous cardiac computed tomography performed for attenuation correction showed presence of intrapericardial hepatic tissue in an anterior diaphragmatic hernia. the herniated tissue was noted to influence the perfusion image and cause the defect. to date, this is a unique finding based on review of literature.