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The Snoopy sign

Authors:
Nikolaos Panagiotopoulos at Cleveland Clinic
Nikolaos Panagiotopoulos
James Barnard at Manchester University NHS Foundation Trust
James Barnard
Francis Wells
Francis Wells
Francis Wells
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The Snoopy sign
Nikolaos Panagiotopoulos*, James Barnard and Francis Wells
Department of Cardiothoracic Surgery and Transplantation, Papworth Hospital, Cambridge, UK
* Corresponding author. Cardiothoracic Surgery and Transplantation, Papworth Hospital, Papworth Everard, Cambridgeshire, Cambridge CB23 3RE, UK.
Tel: +44-7752194604; email: panagiotopnikos@yahoo.gr (N. Panagiotopoulos).
Received 19 April 2013; received in revised form 16 May 2013; accepted 23 May 2013
Keywords: Mediastinum absence •Cardiac •Congenital
Imaging revealed marked levoposition of cardiac silhouette without
tracheal deviation, ill definition of the right heart border and flat-
tening with elongation of the left heart border, the ‘Snoopy Sign’,
one of the features of congenital complete absence of the pericar-
dium (Figure 1A, C and D), and lung tissue interposition between
the ascending aorta and the pulmonary trunk (Figure 1B).
Figure 1 : Congenital complete absence of the pericardium. (A) Characteristic posteroanterior radiograph of the patient with congenital complete absence of the peri-
cardium. Note the marked levoposition of the cardiac silhouette, loss of right heart border, prominent main pulmonary artery, flattening and elongation of the left
heart border (snoopy sign) and lung tissue interposing between the main pulmonary artery and the aorta (arrow). (B) Chest CT mediastinal setting shows characteristic
interposition of lung tissue (arrow) between the aorta (AO) and the pulmonary artery (PA). (C) Chest CT coronal setting shows flattening and elongation of the left
heart border (snoopy sign). (D) Chest CT axial setting showing leftward and posterior rotation of the heart and the absence of the pericardial layer over the posterior
portion of the heart.
© The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
European Journal of Cardio-Thoracic Surgery 45 (2014) 586 IMAGES IN CARDIO-THORACIC SURGERY
doi:10.1093/ejcts/ezt331 Advance Access publication 30 June 2013
... 17 The space between the aorta and the main pulmonary artery may appear widened due to the presence of the lung tissue between these two vessels, the so called 'Snoopy Sign' (figure 2). 28 This also results in sharp demarcation of the pulmonary artery. 13 One of the first findings appreciated on echocardiography in patients with the complete absence of the pericardium is that the standard views may not apply. ...
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... Transthoracic echocardiography revealed an abnormal atrial-ventricular axis; however, it was difficult to image the heart from the usual parasternal long axis because the apex was shifted laterally and posteriorly and the atria was elongated (Figure 1 B). In addition, the chest x-ray displayed levoposition of the heart with an obscured right heart border, an elongated and flattened left heart border ("Snoopy sign"), 1 Consequently, the patient underwent computed tomography (CT) to determine if there was a congenital absence of the pericardium (CAP). The CT confirmed the leftward displacement of the heart and the absence of the pericardial layer (Figure 1 D). ...
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