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.     

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.     

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.     

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.     

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.     

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.     

应用血管造影鉴别诊断误诊为巴德-吉亚利综合征的隐匿性缩窄性心包炎

目的探讨应用血管造影技术鉴别诊断误诊为巴德-吉亚利综合征的缩窄型心包炎患者。 方法回顾性分析378例以"巴德-吉亚利综合征"为早期诊断的病例,对所有病例均进行常规血管造影检查和术中测压。 结果在所有病例中有5例患者血管造影检查显示下腔静脉和肝静脉管腔通畅,但压力明显高于正常,右心房压力也明显高于正常,定期随访1～24个月,这5例患者均发现不同程度心包钙化,最终进行心包部分或全部剥离术。病理结果:结核性心包炎4例,化脓性心包炎1例,支持缩窄型心包炎诊断。 结论缩窄性心包炎部分临床病例症状不典型易误诊,建议有条件单位可应用血管造影技术进行下腔静脉、肝静脉、心脏各房室造影和测压明确有无上述血管疾患。     

Septal bounce in constrictive pericarditis. Diagnosis and dynamic evaluation with multidetector CT

Sixteen-slice multidetector CT findings of a case of constrictive pericarditis in a pediatric patient are presented. Multidetector CT depicted a variety of diagnostic findings including dynamic evaluation of interventricular septal motion through the cardiac cycle, documenting a diastolic septal bounce. This case illustrates the full capabilities of multidetector cardiac CT in the evaluation of pericardial pathology.     

Chemotherapy-induced pericarditis on F-18 FDG positron emission tomography scan

F-18 FDG positron emission tomography (PET) is a highly valuable imaging tool in evaluation and follow up of lymphoma and many other malignancies. Constrictive or effusive constrictive pericarditis is an uncommon complication of chemotherapy. The authors report a case in which pericardial FDG uptake was seen on a whole-body PET scan performed for posttreatment follow-up evaluation for a mantle cell lymphoma.     

Symptomatic pericardial constriction without active pericarditis

The decision to undergo pericardectomy for symptomatic pericardial constriction is usually dictated by an image of an abnormal pericardium. We report a case of symptomatic pericardial constriction despite radiographic and pathological evidence of a normal pericardium. The patient was successfully treated with a pericardectomy, with resolution of constrictive hemodynamics and symptoms. Our report suggests that a normal pericardium by computed tomography and biopsy should not preclude pericardectomy for patients who have refractory symptoms, physical findings, and intracardiac pressures diagnostic of constrictive pericarditis.     

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.     

Visualization of right atrial thrombus associated with constrictive pericarditis by indium-111 oxine platelet imaging

A right atrial thrombus is not often seen and only a few reports of visualization have been described. We report a 44-yr-old man who had a large atrial thrombus associated with constrictive pericarditis. Two-dimensional echocardiography and computed tomography showed a large right atrial mass. Indium-111 oxine platelet deposition was demonstrated on the surface of thrombus by platelet imaging. Platelet imaging was useful for differential diagnosis from cardiac tumor, and as an indication for surgical treatment, since right atrial thrombus may have a high risk of pulmonary embolism or severe right heart failure.     

Constrictive pericarditis following inactivated virus COVID-19 vaccine: a case report with review of the literature

Cardiac adverse effects of the COVID-19 vaccine are very rare, myocarditis and pericarditis are the most common amid them, and constrictive pericarditis (CP) is reported to be restricted to a few cases following mRNA COVID-19 vaccines. We report a case of a 72-year-old male patient who developed symptoms of right-sided heart failure, which started after 8 days of receiving the third dose of inactivated virus COVID-19 vaccine and his diagnostic tests comprising transthoracic echocardiography, chest CT scan, cardiac magnetic resonance were in favor of CP. Ultimately, invasive cardiac catheterization confirmed the diagnosis of CP. Due to the lack of satisfactory response to corticosteroid therapy, pericardiectomy was performed, which gave rise to symptom relief progressively and substantially. Considering the temporal course of the patient''s symptoms and exclusion of other possible etiologies based on the patient''s medical history and diagnostic evaluation, immunization with the COVID-19 vaccine was recognized as a culprit for developing CP. Despite being a scarce phenomenon, the COVID-19 vaccine could have a tendency to provoke pericardial inflammation in so far as causing CP. Hence, physicians should have a high index of suspicion in these circumstances and accelerate the diagnostic investigation.     

Constrictive pericarditis causing a positive TI-201 SPECT stress test for myocardial ischemia

A case of constritive pericarditis was demonstrated by a positive thallium SPECT stress test for myocardial ischemia. After pericardiectomy, the repeat thallium stress test was normal. The disappearance of the criteria for a positive test suggests that constrictive pericarditis can cause myocardial ischemia, which can be demonstrated by thallium SPECT stress testing.     

Pr?valenz und klinische Bedeutung inzidenteller Herzbefunde im nicht EKG-getriggerten Thorax-CT

Background

The purpose of this study was to evaluate the prevalence and clinical significance of incidental cardiac findings in non-ECG-gated chest CT.

Patients and methods

Non-ECG-gated chest CT examinations of 300 patients were retrospectively analyzed for incidental cardiac findings. Subsequently, these findings were evaluated for their clinical relevance by a cardiologist.

Results

A total of 107 out of 300 examined patients had 174 incidental cardiac findings including coronary calcification (90), aortic/mitral valve calcification (42), iatrogenic changes (23), pericardial effusion (6), dilatation of the heart (4), myocardial changes (3), thrombus in the left ventricle (2), constrictive pericarditis (2) and atrial myxoma (1). Of the cardiac findings 51% were described in the written report and in 53 out of the 107 patients the cardiac findings were unknown. Newly detected incidental findings from 8 patients were rated as clinically significant: pericardial effusion (4), constrictive pericarditis (1), thrombus in the left ventricle (1), atrial myxoma (1) and dilatation of the heart (1).

Conclusion

Incidental cardiac findings are frequent in non-ECG-gated chest CT and may have a high clinical relevance.     

Diagnostic imaging of Budd-Chiari syndrome in adults and children

Budd-Chiari syndrome is caused by the obstruction of the hepatic veins or of the inferior vena cava. It is characterized by the classic symptomatological triad: ascites, hepatomegaly, and abdominal pain. In 2/3 cases its etiology remains unknown. Budd-Chiari syndrome may be associated with polycythemia vera, neoplasms, chronic leukemia, congenital abnormalities, hypercoagulation conditions, pregnancy, oral contraceptives, and constrictive pericarditis. Even though its clinical diagnosis is difficult, radiology plays a decisive role with US, CT, MR imaging and, above all, angiography; the latter, together with liver biopsy, generally provides with an unquestionable diagnosis. Through the definition of stage of the disease, of level (intrahepatic, venous, caval, cardiac), of type (intrinsic or extrinsic), and degree of both obstruction and consequent development of collateral channels, radiology determines which patients should undergo a medical or a surgical treatment. In some case, percutaneous angioplasty can be performed. Four cases of Budd-Chiari syndrome, including two children, were investigated with US, CT, angiography, and liver biopsy; MR imaging was also employed in one case. The underlying cause was identified in 3 patients: constrictive pericarditis of probable congenital origin and web occlusion of the inferior vena cava near the right atrium in the 2 children; hepatic vein thrombosis due to essential thrombocythemia in the third case. In the fourth patient, thrombosis of the inferior vena cava and hepatic veins was unexplained. The diagnosis was established by means of liver biopsy and phlebography of the hepatic veins. Good diagnostic information was also supplied by non-invasive techniques, such as US, CT, and MR imaging.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

46例缩窄性心包炎围术期处理体会

目的 探讨缩窄性心包炎的围术期处理方法.方法 回顾性分析2005年5月—2011年4月解放军总医院心外科收治的46例缩窄性心包炎患者的临床资料,其中男37例,女9例.年龄11～71岁,平均45岁,术前心功能(NYHA 分级)Ⅱ级11例,Ⅲ级30例,Ⅳ级5例.所有患者术前行超声心动图及纵隔CT以确诊.46例患者均于全麻下经胸部正中切口行心包剥脱术,同期行房间隔缺损修补术2例,冠状动脉旁路移植术1例.手术前后行心脏超声测量各心房、心室腔大小.手术前经股静脉测量中心静脉压(CVP),术中及术后经颈静脉动态监测CVP.结果 本组患者无围术期死亡.术后二次开胸止血1例,出现低心排综合征6例,Ⅱ型呼吸衰竭1例,消化道出血1例,均治愈后出院.心脏超声示术后左房内径(LA)较术前明显减小(P=0.001),左室内径(LV)、右室内径(RV)较术前增加(P=0.002,P=0.030),CVP较术前下降(P=0.000).术后随访4个月～6年,所有患者腹胀、胸闷症状消失,心功能Ⅰ级40例,Ⅱ级6例.结论 正确的围术期处理及充分合理的心包剥脱,可使缩窄性心包炎患者术后心功能明显改善.     

缩窄性心包炎的MRI诊断

目的 评价MRI检查缩窄性心包炎的诊断价值。材料与方法 回顾性分析临床证实的26例缩窄性心包炎MRI表现。结果 MRI发现24例心包有增厚,2例正常。增厚的心包T1WI上20例呈中等信号,4例为低信号。右心室腔呈管状狭窄者6例,右心室前壁僵、右心室腔呈三角形者13例,5例右心室略大。11例电影MRI均显示右心室受限。右房除2例外均有不同程度的增大,左房有4例增大,19例发现有上、下腔静脉扩张。结论 MRI能直接显示极大多数病例增厚的心包,并确定其部位和范围,对诊断缩窄性心包炎和与限制性心肌病鉴别有重要价值,可在某些诊断有争议的病例中选择性应用。     

Magnetic resonance imaging in the evaluation of the pericardium. A pictorial essay

Magnetic resonance (MR) is an ideal technique for the evaluation of the pericardium since it enables the combination of high resolution anatomical images of the pericardial layers with functional information concerning the impact of pathology on diastolic heart function and cardiac filling in particular. In comparison with echocardiography, which remains the first choice technique for the study of the pericardium, MR provides larger fields of view allowing the visualisation of the entire chest, higher spatial and contrast resolution and greater reproducibility. The technique becomes particularly useful when ultrasound imaging does not provide adequate diagnostic information or requires further characterisation; 'non-echoic' patients, loculated pericardial effusions, focal thickening of the layers and pericardial masses are usually better assessed with MR. The method also provides valuable diagnostic information for establishing the diagnosis of constrictive pericarditis and to differentiate this condition from restrictive cardiomyopathy. The aim of this paper is to present the role of MR imaging in the assessment of a patient with suspected pericardial disease, and discuss the MR technique, anatomy and the main pathological conditions.