Congenital arhinia is one of the rare craniofacial malformation that may cause severe respiratory distress at birth due to upper airway obstruction. Our patient, whose abnormalities were only detected after delivery in our centre, is the first reported case of congenital arhinia in Malaysia. Contrary to popular belief that neonates are obligate nasal breather, our patient adapted well to breathing through mouth before an elective tracheostomy was performed on day four of life.
Congenital absence of the pericardium is a rare condition,which is frequently missed due its subtle presentation. It may be misdiagnosed as another condition causing right heart dilatation such as an intracardiac shunt. We report the finding of diastolic pressure alternans during cardiac catheterization in this single case report of a patient with congenital total absence of the pericardium. The occurrence of this phenomenon is hypothesized to be due to excessive cardiac hypermobility and paradoxical septal movement. We propose that this finding may be a useful clue to the diagnosis.