Recent role of imaging in the diagnosis of pericardial disease

Abstract

Noninvasive cardiac imaging techniques have made a striking impact on the evaluation and management of pericardial disorders. Two-dimensional and Doppler echocardiography are the methods of choice in the evaluation of pericardial effusion and cardiac tamponade. Magnetic resonance imaging, computed tomography, and transesophageal echocardiography are valuable in the assessment of pericardial thickness in suspected cases of constrictive pericarditis. Filling dysfunction associated with constrictive pericarditis is well demonstrated by Doppler flow velocity recordings of intracardiac flow jets, and pulmonary and hepatic venous flow streams. Tissue Doppler echocardiography, by which tissue velocity of myocardial regions and mitral annulus are analyzed, offers additional information in the differentiation of constrictive pericarditis and restrictive cardiomyopathy. Magnetic resonance imaging and computed tomography are the techniques of choice in the recognition of unusual disorders such as pericardial cysts, tumors invading the pericardium, and congenital absence of pericardium. Noninvasive imaging aids not only in the diagnosis of pericardial diseases, but also in the guidance of optimal therapy.

Pericardial disease and pericardial tamponade

“…Small effusions have an echo-free space of Ͻ5 mm, moderate-sized effusions range between 5 and 10 mm and are circumferential, and Ͼ10 mm indicates a large effusion. Fluid adjacent to the right atrium is an early sign of pericardial effusion (22).…”

Protein-losing enteropathy as the principal manifestation of constrictive pericarditis

“…Computed tomography is able to detect pericardial calcifications that are often helpful to make the diagnosis of constriction. 10,11 Magnetic resonance imaging exhibits superb contrast resolution and multiplanar capability, thus providing an exact evaluation of the pericardium thickness; it is currently the imaging diagnostic procedure of choice for the detection of constrictive pericarditis. [10][11][12] Nevertheless, the diagnosis cannot generally be established with certainty by noninvasive methods.…”

Heart in a Hard Cage: Startling Calcific Constrictive Pericarditis

“…12 Although many patients with abdominal symptoms as a part of evaluation undergo CT, the diagnosis can often be overlooked by abdominal radiologists. 12 Echocardiography is the most common method used for diagnosing pericardial diseases [13][14][15][16] ; however, CT and magnetic resonance imaging are now being used more frequently, providing better direct visualization of the pericardium. [12][13][14][15] CT scans are best for demonstrating pericardial calcification, as is magnetic resonance imaging for functional abnormalities of the ventricles.…”

“…If the thickness is >4 mm, it is considered an abnormally thickened pericardium. [12][13][14][15][16][17] A pericardium with >6 mm thickness has a high specificity for constriction, 18 although some studies have found that constrictive pericarditis can occur in patients with normal pericardial thickness as well. 17 Apart from direct findings, some of the indirect findings such as a dilated inferior vena cava, dilated hepatic veins, mesenteric soft tissue stranding, and liver mottling may also be observed on imaging studies.…”