Pericardial diseases have changed their epidemiology in the past few years. With the aging population and decreasing incidence of communicable diseases, the causes of pericardial diseases have significantly changed from infectious and malignant to postradiation and cardiac surgery causes. Despite that, pericardial diseases remain difficult to diagnose. The accurate and timely diagnosis of these diseases is essential to avoid the late sequela of pericardial constriction and pericardial cirrhosis. Echocardiography remains the first test of choice for the assessment of patients with suspected pericardial diseases. Most patients with acute pericarditis have a self-limiting course and do not need further imaging. However, in the era of multimodality imaging, other modalities, namely, computed tomography (CT) and magnetic resonance imaging (CMR), are often utilized in complex cases. These two modalities provide a wide-open view of the pericardium and adjacent structures. They have high resolution to assess pericardial calcification, a hallmark of many diseases especially tuberculous constrictive pericarditis. CMR is also unique in its ability to assess pericardial late gadolinium enhancement (LGE) and edema. These have been recently suggested to be very important in the progression from acute pericarditis to constrictive pericarditis. In addition, they provide prognostic value to assess which patients are at high risk of developing heart failure and resource utilization. Thus, in the current era, patients with suspected complex pericardial diseases will need a multimodality approach rather than a single modality approach.

Low-dose CT could be used as a tool to rule out the presence of fatty liver if neither liver attenuation of less than 40 HU nor liver-to-spleen below 1.1 is present.

Background and aim of the work: Pediatric cardiac patients often undergo non-cardiac surgical procedures and many of these patients would require intensive care unit admission, but can we predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Numerous preoperative and intraoperative variables were strongly associated with ICU admission. Given the variations in the underlying cardiac physiology and the diversity of noncardiac surgical procedures along with the scarce predictive clinical tools, we aimed to develop a simple and practical tool to predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Material and methods This is a retrospective study, where all files of pediatric cardiac patients who underwent noncardiac surgical procedures from January 1, 2015, to December 31, 2019, were reviewed. We retrieved details of the preoperative and intraoperative variables including age, weight, comorbid conditions, and underlying cardiac physiology. The primary outcome was the need for ICU admission. We performed multiple logistic regression analyses and analyses of the area under receiver operating characteristics (ROC) curves to develop a predictive tool. Results In total, 519 patients were included. The mean age and weight were 4.6 ± 3.4 year and 16 ± 13 Kg respectively. A small proportion (n = 90, 17%) required ICU admission. Statistically, there was strong association between each of American society of anesthesiologist’s physical status (ASA-PS) class III and IV, difficult intubation, operative time more than 2 hours, requirement of transfusion and the failure of a deliberately planned extubation and ICU admission. Additional analysis was done to develop a Cardiac Anesthesia Tool (CAT) based on the weight of each variable derived from the regression coefficient. The CAT list is composed of the ASA-PS, operative time, and requirement of transfusion, difficult intubation and the failure of deliberately planned extubation. The minimum score is zero and the maximum is eight. The probability of ICU admission is proportional to the score. Conclusion CAT is a practical and simple clinical tool to predict the need for ICU admission based on simple additive score. We propose using this tool for pediatric cardiac patients undergoing non-cardiac procedure.