Parchment Heart

Sir William Osier ¹ introduced this term in the sixth edition (1905) of his book, The Principles and Practice of Medicine. He described ‘an extraordinary heart in the McGill College Museum showing a parchment-like thinning of the walls with uniform dilatation of all the chambers; in places in the right auricle and ventricle, only the epicardium remains.’ Drawings of the heart that Osier described were printed in a 1950 article ² (Figure 1). At that time no other similar case was found in a search of the literature. In 1952, two similar cases were reported. The first, reported as the weekly clinicopathological exercise in the May 15 issue of the New England Journal of Medicine, was a 24-year-old woman with extreme thinning of the right ventricle and right auricle’. Although the Osier case was mentioned in the discussion of this patient’s case the final diagnosis given was ‘cardiac dilatation of the right heart, extreme, ? congenital.’ The second case, reported by Henry Uhl (Johns Hopkins) concerned an 8-month-old infant who died of complications of a congenital heart disorder ⁴ . At autopsy, almost total absence of the myocardium was noted exclusively in the right ventricular wall and the auricle (atrium) was hyper-trophied. Uhl did not mention Osier’s description. Uhl’s name is now used as the eponym for this disorder which radiologists can diagnose by angiography, echocardiography, computerized tomography or magnetic resonance imaging (Figure 2). Figure 1 ‘Two views of the heart with walls of parchment-like thinness.’ Reprinted from Segalll Parchment heart (Osier). <italic>Am. Heart J.,</italic> 1950,40,948–50, with permission of Mosby-Yearbook Inc. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig60_1_B.jpg"/> Figure 2 Parchment heart shown in stop-frame four-chamber real-time echocardiogram (left) and diagnostic sketch (right) illustrating the large right ventricle. Reprinted from Bewick et a/.’. Dilated right ventricular cardiomyopathy. <italic>Chest,</italic> 1986, 90, 300–2, with permission https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig60_2_B.jpg"/>