Constrictive pericardial hemodynamics made easy cath lab digest. Learn about symptoms, diagnosis and treatment for pericarditis a condition. The presentation of patients with constrictive pericarditis can mimic numerous clinical disease states, including restrictive cardiomyopathy, heart failure, and liver disease. The true population prevalence is unknown, but amongst those with viral pericarditis it has been estimated to occur in less than 0. The echocardiographic findings are detailed and the recent advances in doppler flow velocity patterns of pulmonary, mitral, tricuspid valves and hepatic veins are reported. Cmr tagging may offer a novel, accurate means of diagnosing constrictio. This process is experimental and the keywords may be updated as the learning algorithm improves. Pathophysiology and diagnosis of constrictive pericarditis. Cardiovascular magnetic resonance in pericardial diseases. Defined by thickening of pericardium 4mm impeding diastolic filling. Constrictive pericarditis is a potentially treatable cause of diastolic heart failure that arises because a diseased, inelastic pericardium restricts ventricular diastolic expansion. Pericardial disease, pericardial effusion, constrictive pericarditis. The normal pericardium is a thin sac consisting of fibro. Integrative imaging selfassessment modules lifelong learning for.
Secondary changes of constrictive pericarditis were also seen in the form of moderate right pleural effusion and tricuspid regurgitation. Jun 11, 2020 differentiation of constrictive pericarditis and restrictive cardiomyopathy by doppler echocardiography. A persistently dilated inferior vena cava following centesis was present in all cases and echolucent material in the pericardial spacepericardial thickening was seen in the majority of patients. Aug 23, 2018 constrictive pericarditis is longterm, or chronic, inflammation of the pericardium.
Emerging countries and tuberculosis constriction american. There are bilateral pleural effusions present white arrows, a common finding in constrictive pericarditis. We utilized constrictive pericarditis cp and restrictive cardiomyopathy rcm as an. May 04, 2009 calcified constrictive pericarditis, axial t1weighted spinecho cmr before a and after b administration of gadoliniumchelates, cine cmr at end diastole c and end systole d in the same imaging plane. Diffuse upwardly concave stsegment elevations in the initial ecg and pericardial effusion on echocardiography confirm the diagnosis. He was continued on colchicine and started on a slow prednisone taper along with low dose furosemide. Assessment of ventricular coupling with realtime cine mri and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy.
Echocardiographic diagnosis of constrictive pericarditis. Cardiac filling occurs until the pericardium can stretch no further. Mmode echocardiography in constrictive pericarditis. Constrictive pericarditis with a history of chest radiation. Differentiate constrictive pericarditis from restrictive cardiomyopathy by assessing septal motion. Feb 01, 2009 constrictive pericarditis is caused by adhesions between the visceral and parietal layers of the pericardium and progressive pericardial fibrosis that restricts diastolic filling of the heart. Magnetic resonance imaging of constrictive pericardial disease. Occult constrictive pericarditis occasionally constriction is not obvious during routine examination but manifests when there is a rapid fluid challenge.
European association of cardiovascular imaging eacvi position. Constrictive pericarditis radiology reference article. The visceral pericardium is a mesothelial monolayer that is adherent to the epicardium, which is reflected back on itself at the level of the great vessels. Clinically, it is difficult to differentiate between constrictive pericarditis and restrictive cardiomyopathy.
Management of refractory constrictive pericarditis. The echocardiographic findings are detailed and the recent advances in doppler flow velocity patterns of pulmonary. Constrictive pericarditis was verified by means of surgery andor catheterization in 17 patients. Pericardial calcifications constrictive pericarditis. Further, pericardial characterization by cmr has provided novel. Conversely 2750% of patients with constrictive pericarditis have pericardial. The cineangiocardiogram in constrictive pericarditis. With special reference to left ventricular volumes and related hemodynamic findings. Pericardial disease online cardiovascular pathology course. Learningradiology pericardial calcifications, constrictive. Constrictive pericarditis can result in debilitating congestive. Sep 07, 2020 constrictive pericarditis is the result of encasement of the heart by a thick and inelastic pericardium that limits the heart volume figure 1. Apr 08, 2019 echodoppler features of constrictive pericarditis are common postpericardiocentesis, with 16% of our cohort meeting criteria for ecp. Background effusiveconstrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial.
Myocardial calcification is a sign of prior infarction, while pericardial calcification is strongly associated with constrictive pericarditis. Ct and mr imaging of pericardial disease bogaert and francone but importantly, the pericardial sac, having a slightly negative pressure, acts not only as an anatomic barrier but also as an important physiologic intermediary between the heart and the remainder of the chest. A detailed history and careful physical examination together with judicious diagnostic imaging usually helps in targeting the correct diagnosis. Constrictive pericarditis an overview sciencedirect topics.
Left pleural empyema and few calcified mediastinal lymph nodes suggest to the possible tubercular aetiology for pericarditis. We present the utility of cardiac magnetic resonance imaging, a noninvasive. We exploited the clinical potential of novel realtime cine sequences to study the effects of. Cardiac tamponade cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Part of the developments in cardiovascular medicine book series dicm. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. Online learning catalog understanding moc products and. Case of the week 541 on awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing over 300 powerpoint lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. Constrictive pericarditis is caused by adhesions between the visceral and parietal layers of the pericardium and progressive pericardial fibrosis that restricts diastolic filling of the heart.
Pericarditis usually leads to pericardial effusion, or constrictive pericarditis. Role of imaging in penetrating and blunt traumatic injury to the heart. A constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened, or calcified pericardium. Effusiveconstrictive pericarditis radiology reference. The pericardium is the saclike membrane that surrounds the heart. Thickened pericardium was observed in 88% of patients with proved constrictive pericarditis. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. Effusive constrictive pericarditis is a rare constrictive pericardial syndrome of a constellation of findings in which a fibrotic visceral pericardium and a pericardial effusion contribute to cardiac tamponade pathophysiology. Acute pericarditis is usually selflimiting 26 weeks. Pathology although historically infective pericarditis was the most common cause, a wide vari. Idiopathic effusiveconstrictive pericarditis in a teenager. Epidemiology, causes and management differs from those other sources in that a conscious effort was made to present the information in this textbook in a how to format, with the chapters and text structured in such a way as to provide the reader with a clear stepbystep narrative.
The normal pericardium is a thin sac consisting of fibro elastic tissue and contains a small amount of fluid. Constrictive pericarditis european journal of internal medicine. Constrictive pericarditis and atrial septal defect, secundum type. Even with high quality echocardiography and cardiac radiology, these patients. Idiopathic chronic constrictive pericarditis had the best prognosis, with 7year survival at around 88%, followed by postsurgical 66% and postradiation 27% chronic constrictive pericarditis. Constrictive pericarditis is the end stage of any pericardial disease process.
Cardiac mri can be useful for evaluation of constrictive pericarditis, through a combination of anatomic and functional information. Frontal chest radiograph shows curvilinear calcification surrounding the heart consistent with calcific pericarditis. New cardiac imaging algorithms to diagnose constrictive pericarditis versus restrictive cardiomyopathy. It is important to distinguish between constrictive pericarditis and restrictive cardiomyopathy as the former benefit from pericardial. Constrictive pericarditis or perhaps better termed pericardial constriction is a type of pericarditis which leads to diastolic dysfunction and potential symptoms of. Oct 01, 2003 patients with constrictive pericarditis frequently present with symptoms of heart failure, such as dyspnea, orthopnea, and fatigability, and occasionally may present with liver enlargement and ascites. Inflammation of the pericardium from various origins, such as infection, neoplasm, autoimmune process, injuries, or druginduced. Coronal reformatted ct of chest shows markedly thick pericardial calcification around the heart from patient with history of tuberculous pericarditis. Automated techniques using novel machine learning approaches may. Constrictive pericarditis cp is defined as impedance to diastolic filling caused by a fibrotic pericardium. Patients with constrictive pericarditis frequently present with symptoms of heart failure, such as dyspnea, orthopnea, and fatigability, and occasionally may present with liver enlargement and ascites. Effusive constrictive pericarditis is a rare clinical syndrome with constrictive hemodynamics that persist after the pericardial effusion is drained. Mar, 2017 constrictive pericarditis cp is a relatively uncommon form of clinical heart failure. Ct and mr imaging of pericardial disease radiographics.
Pericardial calcification is usually seen in individual patients with a history of pericarditis and may be associated with constrictive pericarditis. Ossification of the posterior longitudinal ligament opll. Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. Radiation pericarditis pericardial constriction and restrictive cardiomyopathy may coexist in patients with radiation heart disease, which makes the diagnosis challenging. Online learning catalog understanding moc products and resources.
Affected patients present with heart failure with predominant rightsided symptoms and signs. A mildly thickened, hypointense appearing pericardium is visible over the right heart arrows. The most common cause of pericardial con stri ction in developed countries is idiopathic pericarditis followed by trauma commonly related to cardiac surgery and radiation injury. If cardiac tamponade or constrictive pericarditis develops, cardiac output can be severely reduced. Shah, md, facc,t harry 1, driedger, md, ralph shabetai, md, facc. Constrictive pericarditis radiology reference article radiopaedia. The most sensitive sign for a pericardial effusion on cxr is enlargement of the.
The test can be used to look for thickening that may be a sign of co. Echocardiography diagnostic criteria for constriction. A cognitive machine learning algorithm for cardiac imaging. Although pericardial disease often represents a diagnostic challenge, ct and mr imaging. Cardiac magnetic resonance radiofrequency tissue tagging for. A pilot study for differentiating constrictive pericarditis from. Multimodality imaging for the diagnosis and treatment of constrictive.
Aug 26, 2020 he was diagnosed with constrictive pericarditis. Constrictive pericarditis and restrictive cardiomyopathy. Prior exposure to ionizing radiation is associated with poor longterm outcome because it induces cardiomyopathy as well as pericardial disease. Cognitive machinelearning algorithm for cardiac imaging. New cardiac imaging algorithms to diagnose constrictive. The causes of constrictive pericarditis have changed over time.
Pericardial calcification radiology reference article. Constrictive pericarditis prevalence, causes and clinical. Calcification in the pericardium is most likely inflammatory in nature. The sensitivity, specificity, and accuracy of mr imaging in the diagnosis of constrictive pericarditis were 88%, 100%, and 93%, respectively. Preload reduction to unmask the characteristic doppler features of constrictive pericarditis. This axial ct image of the chest is displayed using bone windows to show the calcifications of the pericardium red arrows. Mar 09, 2015 a constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened, or calcified pericardium. Chest radiograph signs suggestive of pericardial disease.
Pericardial knock in constrictive pericarditis youtube. Apr 12, 2016 historically, a 6month course of antituberculous chemotherapy and pericardiectomy, when necessary, formed the cornerstone of managing tuberculous constrictive pericarditis. Defined by thickening of pericardium 4mm impeding diastolic filling thickened pericardium may calcify 50% calcified pericardium almost always implies. Constrictive pericarditis can be caused by any of the disorders that affect the pericardium shown in box 9. Multimodality imaging is part of the management of pericardial diseases. Despite an additional 3 months of medical therapy, his heart failure symptoms worsened, and he was referred to our facility for further management. Constrictive pericarditis often presents with insidious signs and symptoms and is notoriously difficult to distinguish from restrictive cardiomyopathy and other abdominal pathology. Echo in constrictive pericarditis all about ultrasound blog. Recognizing the basics with student consult online access. Francone m, dymarkowski s, kalantzi m, rademarkers fe, bogaert j.
Constrictive pericarditis cp is a relatively uncommon form of clinical heart failure. Constrictive pericarditis is one of the most serious sequelae of tuberculous pericarditis, occurring in 30% to 60% of patients, despite prompt antituberculosis treatment and the use of corticosteroids. A man with constrictive pericarditis had a highpitched early diastolic sound on auscultation at the left lower sternal border, characteristic of a prominent. Giorgi b, mollet nra, dymarkowski s, rademakers fa, bogaert j 2003 assessment of ventricular septal motion in patients clinically suspected of constrictive pericarditis, using magnetic resonance imaging. Computed tomography ct and magnetic resonance imaging mri. May 01, 20 the risk of constrictive pericarditis after acute pericarditis is relatively low in viral or idiopathic acute pericarditis pericarditis, particularly in patients with an incessant course and large pericardial effusions. Constrictive pericarditis, still a diagnostic challenge. Constrictive pericarditis is potentially curable by a pericardiectomy.
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