CT and MR Imaging of Pericardial Disease

Abstract

In the evaluation of pericardial disease, computed tomography (CT) and magnetic resonance (MR) imaging traditionally have been used as adjuncts to echocardiography. However, CT and MR imaging are particularly useful as sensitive and noninvasive methods for evaluating loculated or hemorrhagic pericardial effusion, constrictive pericarditis, and pericardial masses. Both CT and MR imaging provide excellent delineation of the pericardial anatomy and can aid in the precise localization and characterization of various pericardial lesions, including effusion, constrictive pericarditis and pericardial thickening, pericardial masses, and congenital anomalies such as partial or complete absence of the pericardium. Both modalities provide a larger field of view than does echocardiography, allowing the examination of the entire chest and detection of associated abnormalities in the mediastinum and lungs. Soft-tissue contrast on CT scans and MR images also is superior to that on echocardiograms. Given the many potential applications of these modalities in the evaluation of pericardial diseases, familiarity with the CT and MR imaging features of these diseases is important.

Unusual cause of pyopericardium with tamponade

“…CT or magnetic resonance are better than echocardiography during evaluation of pericardial disease as they can simultaneously show anatomical abnormalities of lung and mediastinal structures with better soft tissue contrast and larger field of vision than echocardiography. 8 Initially, we did not consider TB as aetiology as the illness resembled acute bacterial pneumonia with pyopericardium. As the patient did not show significant clinical improvement with antibiotic therapy and pericardial drainage, the only positive sputum bacterial culture report was considered to be probably due to contamination.…”

Grande cisto pericárdico manifestando-se com compressão das câmaras cardíacas direitas

“…These cysts are caused by a defect in the development of the coelomic cavity and is consistently adhered to the pericardial leaflet, although communication with the pericardial cavity may occur [5]. They are classically located next to the right anterior cardiophrenic sinus, being its occurrence in other sites much less common [6].…”

Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging

“…20 Even in cases with imaging findings concerning for malignancy, biopsy is often required for diagnosis because imaging findings are often non-specific and pericardial fluid cytology may be negative. [21][22][23] Caution is required in the interpretation of pericardial fluid analysis negative for malignancy regardless because in 25% of patients who have a pericardial biopsy with evidence of malignancy the initial fluid cytology was negative; however, up to two thirds of patients with known malignancy and a pericardial effusion do not have a neoplastic source of their effusion by biopsy. [24][25][26] Treatment and prognosis of these tumors are beyond the scope of this review.…”

“…89 Their density is slightly higher than water, up to approximately 30-40 HU, and they do not enhance with contrast administration. 4,21,77,89,90 Cardiac magnetic resonance imaging…”

“…28 Mesothelioma can be identified as an irregular, diffuse thickening of the pericardium with effusion, with an appearance very similar to metastatic involvement. 21,28,33,43 Lymphadenopathy can also be identified by cCT and is an important associated finding suggestive of malignancy.…”