Sternal depression and pericardial defect with prolapse of the right ventricular outflow tract

This patient has a sternal depression which pushes the heart to the left, displacing the apex leftwards. There is an accompanying straight right border of heart shadow in the region of the pulmonary artery. On left border, there is unusually prominent left bulge and this is due to a pericardial defect which permits prolapse of the right ventricular outflow and main pulmonary artery through it.