Constrictive pericarditis and restrictive cardiomyopathy: evaluation with MR imaging.

Twenty-nine patients who were referred with the possible diagnosis of constrictive pericarditis underwent electrocardiographically gated transverse spin-echo magnetic resonance (MR) imaging to determine the accuracy of spin-echo MR imaging for the diagnosis of constrictive pericarditis and to compare the morphologic features of constrictive pericarditis with those of restrictive cardiomyopathy as seen on spin-echo MR images. Constrictive pericarditis was verified by means of surgery and/or catheterization in 17 patients. The sensitivity, specificity, and accuracy of MR imaging in the diagnosis of constrictive pericarditis were 88%, 100%, and 93%, respectively. Thickened pericardium was observed in 88% of patients with proved constrictive pericarditis. Pericardial thickening was not identified in patients with restrictive myocarditis (n = 4). The most frequent site of pericardial thickening was over the right ventricle. In constrictive pericarditis, the signal intensity of the thickened pericardium was similar or decreased compared with that of the myocardium. Indirect findings of impaired right ventricular diastolic filling (eg, dilatation of the inferior vena cava and right atrium) were identified in constrictive pericarditis and restrictive cardiomyopathy. MR imaging can serve as a noninvasive examination for the definitive diagnosis of constrictive pericarditis and can help distinguish between constrictive pericarditis and restrictive cardiomyopathy on the basis of pericardial thickness.     

Gallium-67 citrate localization in the heart secondary to constrictive pericarditis with myocardial fibrosis

Scintigraphy has demonstrated gallium-67 accumulation within the heart in pericarditis and cardiomyopathies of various kinds. We present a case report of a 63-yr-old man with multisystem disease who showed extensive myocardial uptake of Ga-67 by scintigraphy. At autopsy, constrictive pericarditis with myocardial fibrosis was found. Gallium-67 localization has not been documented previously in myocardial fibrosis accompanying constrictive pericarditis.     

Computed tomography and magnetic resonance imaging of the pericardium: anatomy and pathology.

The purpose of this article is to review the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of the pericardium and pericardial diseases. Because patients with pericardial diseases usually present with nonspecific symptoms, these diseases may not be detected until they have reached an advanced stage. It is therefore important to distinguish between normal pericardial structure and disease. Multiplanar reconstruction images of CT and MRI are useful for evaluating faint changes of the pericardium. The specific pericardial diseases described in this article include pericardial cyst, constrictive pericarditis, pericarditis with radiation pericarditis, postoperative pericardial hematoma, and cardiac tamponade due to a paracardiac mass (lymphoma).     

Constrictive Pericarditis Presenting as Isolated Ascites

Constrictive pericarditis is a rare cause of right-sided heart failure secondary to a stiff, non-compliant pericardium. Clinical presentation can vary considerably and requires a high suspicion for diagnosis. A 31-year-old male presented to the emergency department with complaints of abdominal distension. An abdominal ultrasound revealed large volume ascites; thus, it was initially suspected he had underlying cirrhosis. However, an echocardiogram revealed a diagnosis of constrictive pericarditis. It''s important for clinicians to consider constrictive pericarditis in a patient presenting with unexplained right-sided heart failure.     

Constrictive pericarditis presenting with an outpouching of the right ventricle free wall simulating an aneurysmal dilatation

We present a case of constrictive pericarditis resulting in an outpouching of the right ventricular free wall, simulating a right ventricular free wall aneurysm. The present case is, to the best of our knowledge, the first reported right ventricular free wall aneurysm-like outpouching adjacent to surrounding regions of thickened pericardium in a patient with constrictive pericarditis.     

Sentinel case of group A beta-hemolytic streptococcus causing constrictive pericarditis presenting as hypogammaglobulinemia

This is a unique case of a previously healthy 7-year-old boy, which highlights the importance of considering immunodeficiency when a rare infection occurs. In the following case report, the patient develops constrictive pericarditis secondary to group A beta-hemolytic streptococcal infection. As a result of this infection, we speculate that he develops hypogammaglobulinemia secondary to the documented association between constrictive pericarditis and intestinal lymphangiectasia because an extensive work-up for a primary immunodeficiency was negative. This is the first case ever to present constrictive pericarditis because of group A beta-hemolytic streptococcal infection.     

MRI of the abnormal pericardium

To evaluate the use of MRI in the diagnosis of pericardial disease, 63 patients with pericardial abnormalities or clinically suspected pericardial disease were studied retrospectively. Twenty-three patients had pericardial effusion, 19 patients had pericardial thickening, and 11 patients were referred for evaluation of masses with possible pericardial involvement. The other 10 patients were referred for differentiation of constrictive pericarditis from restrictive cardiomyopathy and eventually were found to have pericardial hematoma or normal pericardium as assessed by MRI. The calculated size of pericardial effusion by MRI showed a good correlation with semiquantitative echocardiographic estimations. MRI could demonstrate fibrinous adhesions in patients with uremic pericarditis. It was also of great value in the differential diagnosis of constrictive pericarditis vs restrictive cardiomyopathy. Pericardial thickness of more than 4 mm was found in patients with constrictive pericarditis. Normal pericardial thickness was demonstrated by MRI in the three patients with restrictive cardiomyopathy. MRI diagnosed hemopericardium correctly as the cause of constrictive symptoms in two patients. Pericardial thickening in patients after cardiac surgery was commonly found by MRI and usually was not associated with clinical signs of constrictive pericarditis. MRI proved to be useful in the diagnosis of pericardial cysts and in the evaluation of paracardiac masses with possible pericardial involvement. MRI is an important technique in the evaluation of the pericardium. It can provide important additional information when diagnosis cannot be made adequately by other noninvasive imaging techniques.     

Purulent pericarditis presenting as acute abdomen in children: abdominal imaging findings.

Purulent pericarditis is rapidly fatal if untreated [1,2]. With increased development of bacterial resistance to antibiotics, severe bacterial infections in children are becoming more frequent [3,4]. We report two children with purulent pericarditis who presented in a 1-month period for evaluation of acute abdominal distention and signs of sepsis. In both, one evaluated with computed tomography (CT) and one with ultrasound, abdominal findings included periportal edema, gallbladder wall thickening, and ascites secondary to right heart failure from cardiac tamponade. Radiologists should be aware that children with purulent pericarditis may have a normal heart size on radiographs, present with acute abdominal symptoms, and demonstrate findings of right sided heart failure on abdominal imaging.     

缩窄性心包炎的CT表现

作者分析了１６例缩窄性心包炎的ＣＴ表现，结合文献复习进行讨论，认为心包增厚（伴或不伴心包钙化），伴有室间隔扭曲成角和／或下腔静脉扩张者，可考虑为缩窄性心包炎，同时指出ＣＴ是鉴别缩窄性心包炎与限制型心肌病的最佳影像学技术之一。     

99mTc-pyrophosphate imaging in acute pericarditis: a clinical and experimental study.

Fifteen patients with clinical and electrocardiographic features of acute pericarditis underwent myocardial scintigraphy using 99mTc-pyrophosphate. All had normal images. In 5 additional patients with acute pericarditis and evidence of ischemic heart disease, 99mTc-pyrophosphate images showed focal abnormalities in 2 patients and equivocal findings in 2. Serial myocardial radionuclide images were obtained 2 to 18 days after induction of pericarditis in 8 dogs; all images were normal. No stainable tissue calcium was demonstrated histochemically in the pericardium or myocardium of these dogs. Our results suggest that 99mTc-PYP myocardial radionuclide images are normal in acute pericarditis in the absence of ischemic heart disease.     

Pericarditis: Diagnosis,management, and return to play

In athletes who present to their team physician with complaints of chest pain, the diagnosis of pericarditis should be entertained. Although generally self-limited, potential complications include cardiac tamponade and recurrent pericarditis. The typical scenario is of an athlete who had a recent viral upper respiratory illness and now presents with chest pain, friction rub, and characteristic electrocardiographic changes. Additional recommended testing includes complete blood count, erythrocyte sedimentation rate and/or C-reactive protein, cardiac enzymes, chest radiographs, and echocardiogram with Doppler. During acute pericarditis, participation in athletics is contraindicated. Return to play is permissible after there is no longer evidence of active disease. This is confirmed by the absence of effusion on echocardiography and normalization of serum markers of infiammation.     

Pericardial calcification in childhood

Calcific constrictive pericarditis (CCP) in a three-year-old child with symptoms of cardiac compression was confirmed by cardiac catheterization and angiography. Histologic examination of the pericardial tissue removed at operation revealed a tuberculous etiology. Though unusual in the pediatric age group, constrictive pericarditis (CP) may occur in children, most often as a complication of tuberculosis. Pericardial calcification may also develop in children with CP, though this too is rare. The diagnosis of CCP can be established by cardiac catheterization and angiography. Pericardiectomy is the definitive treatment.     

The 'hot halo' sign. Pyogenic pericarditis on In-111 leukocyte scintigraphy.

The authors report a patient with diffuse pyogenic pericarditis and focal myoendocarditis initially detected using In-111 WBC scintigraphy. The patient was in septic shock after hemodialysis for the treatment of chronic renal failure. This was preceded by clinical signs and symptoms of pericarditis thought to be viral in nature. Initial investigations found no septic focus, and the patient was referred for In-111 WBC scintigraphy. This revealed a striking "halo" of increased activity around the heart, strongly suggesting bacterial pericarditis. A subsequent pericardiocentesis yielded 400 ml of purulent material, confirming the diagnosis.     

Angiocardiographic differentiation of constrictive pericarditis and restrictive cardiomyopathy due to amyloidosis.

The cineangiocardiograms and coronary angiograms of two cases of amyloidosis of the heart were compared to six cases of constrictive pericarditis. Three angiographic differentiating points were seen: (1) right ventricular free wall motion showed diastolic restriction in both disorders, whereas the crista supraventricularis, which moved normally in constrictive pericarditis, demonstrated restriction in amyloidosis; (2) ventricles in cases of constrictive pericarditis showed subtle further expansion during atrial systole after initial rapid filling (atrial kick), while in both cases of amyloidosis there was no motion during atrial systole; (3) pericardial thickening in constrictive pericarditis was demonstrated by failure of the distal coronary arteries to reach the surface of the cardiac image. In amyloidosis, the distal coronary arteries normally reached the periphery of the image. All three signs may be useful in differentiation, but the first is the easiest to evaluate. The right anterior oblique or posteroanterior view is the recommended projection.     

Pericardial effusions (85 cases): radiological aspects (author's transl)]

A radiological study of 85 patients with acute pericarditis and effusion included a group of 35 cases observed before the introduction of ultrasonography and a second group of 50 patients in whom the presence of pericarditis had been confirmed by this investigation. The most important conclusions established were the following: --Absence of radiological signs in 55% of cases (group 1 : 46%, group 2 : 60%); normal heart size in 54% (group 1) and 78% (group 2), and increased size in 34% (group 1) and 20% (group 2). --Hilar manifestations (overlapping and obscuring of the left hilar region) in 26% of cases with a clear predominence of the left forms (14 out of 22). The cardiomegaly was not significant in 28% (group 1) and 14% (group 2). --The high frequency of pericarditis with a normal heart size has to be emphasized. The diagnostic value of hilar manifestations is also mentioned; the sign of left hilar overlapping is described in greater detail. --An overall comparison between the two groups shows, more particularly, the equal importance of left hilar manifestations for the radiological diagnosis of pericarditis. In a general way, it would appear that these hilar signs are the only elements which enable objective diagnosis of pericardial effusions on standard films.     

18F-FDG PET/CT在心包炎诊断中的应用价值研究进展

心包炎通常是全身多个系统疾病的一部分以及某些全身疾病的首发表现。因此,找到并去除全身疾病的病因,尽早干预并延缓疾病的进程则有助于预防长期并发症,改善患者预后。由于心包活检获得心包积液或心包组织的难度相对较大,阳性率较低,因此,鉴定心包炎的病因一直都是难点。 18F-FDG PET/CT可一次性将全身的生理代谢...     

Purulent pericarditis in advanced thymoma: A case report

Thymoma is the most common primary anterior mediastinum mass with various clinical manifestations, and one of the manifestations is pericardial effusion. While pericardial effusion in thymoma is usually serous, it can become purulent when an infection occurs in a nearby organ, albeit rare. In this report, we present a rare case of a 27-year-old woman who had purulent pericarditis secondary to an advanced thymoma. The patient came to the emergency department with the chief complaints of worsening chest discomfort, non-productive cough, and fever in the past 2 weeks. The patient was diagnosed with thymoma 5 months prior. Based on the examinations, it was discovered that the patient had pericarditis. After the pericardiocentesis was performed and the fluid was examined, the patient was diagnosed with purulent pericarditis secondary to thymoma. The patient was then treated with intravenous antibiotic and pericardial drain. Unfortunately, the patient''s condition deteriorated, and the patient died on the fifth day of hospitalization. This case highlights an infrequent but potentially life-threatening complication of thymoma. In addition, thymic pathologies should be included as a rare etiology in the differential diagnosis of purulent pericardial effusion.     

Metastatic involvement of the heart and pericardium: CT and MR imaging.

Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma. Tumor may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. Impairment of cardiac function occurs in approximately 30% of patients and is usually attributable to pericardial effusion. The clinical presentation includes shortness of breath, which may be out of proportion to radiographic findings in patients with pericardial effusion or may be the result of associated pleural effusion. Patients may also present with cough, anterior thoracic pain, pleuritic chest pain, or peripheral edema. The differential diagnosis of pericardial effusion in a patient with known malignancy includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis. Any disease process that causes thickening or nodularity of the pericardium or myocardium or masses within the cardiac chambers can mimic metastatic disease.     

Gallium67 scintigraphy in fibrinous pericarditis associated with bacterial endocarditis

An 80-year-old man presented with pyrexia, progressive cardiac failure and inflammation. A diagnosis of pericarditis associated with bacterial endocarditis was suggested from Gallium 67 scintigraphy and confirmed at autopsy. This case of fibrinous pericarditis without effusion could not be diagnosed by echography or routine cardiopulmonary scintigraphy.     

Scintigraphic detection of inflammatory heart disease

Inflammatory diseases of the heart encompass myocarditis, endocarditis and pericarditis. This paper discusses the diagnostic potential of scintigraphy in these entities. In myocarditis, indium-111 antimyosin Fab imaging can visualize active myocyte damage and thus contribute substantially to the diagnosis. Antimyosin uptake is also seen in a large subset of patients with dilated cardiomyopathy, indicating ongoing myocyte injury in these cases. In endocarditis, immunoscintigraphy using monoclonal technetium-99m-labelled antigranulocyte antibodies provides useful diagnostic information in patients with equivocal echocardiographic findings. Immunoscintigraphy seems to indicate the floridity of the inflammatory process in endocarditis and may be used to monitor antibiotic therapy. In pericarditis, the clinical value of scintigraphy has not been convincingly demonstrated. Correspondence to: A.J. Morguet