대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Constrictive Pericarditis

Radiologic Findings

PA and lateral chest radiographs show irregular shell-like calcification along the atrioventricular groove. Enhanced CT scans show calcification along the atrioventricular groove and a small amount of pericardial effusion. Narrowing and tubular deformity of the right ventricle and straightening of the interventricular septum are also noted. Reflux of a contrast material into the hepatic vein with the dilation of the inferior vena cava is noted.

Brief Review

Constrictive pericarditis is an uncommon but potentially curable condition by pericardiectomy and characterized by fibrous or calcific constrictive thickening of the pericardium, which prevents normal diastolic filling of the heart. Constrictive pericarditis may follow any type of pericardial effusion and may develop within two or three months of the effusion, or it may take years to develop. The etiology of pericardial thickening includes M. tuberculosis, idiopathic, non-tuberculous infectious condition, post-radiotherapy, local invasion by malignancy, post-cardiac surgery, post pericardiectomy and sarcoidosis (1). The clinical presentation of constrictive pericarditis and restrictive cardiomyopathy is similar. CT scan has shown a value in differentiating these two condition. Normal pericardial thickness virtually rules out constrictive pericarditis. CT findings in constrictive pericarditis include pericardial thickening (above 3mm), narrowing and tubular deformity of the right ventricle, normal or small ventricular size and straightening of the interventricular septum (2). Irregular calcification may be anywhere over the surface of the heart but is particularly present in regions of the heart where the normal fat is abundant in the artioventricular groove (3). Systemic vein dilatation, hepatosplenomegaly, ascites and occasionally pleural effusion are secondary findings. Reflux of a contrast material into the coronary sinus and hepatic vein may occur following bolus administration of a contrast medium during CT scanning. Not all patients with diffuse or focal regions of pericardial thickening exhibit symptoms of constrictive pericarditis (4). Once constriction has developed, early pericardiectomy has a better prognosis than delay operation.

References

1. Cameron J, Oesterke SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J 1987;113:354-360
2. Ian BS, Trevor A, Howwitz. CT in tuberculous constrictive pericarditis. J Comput Assist Tomogr 1992;16:391-400
3. Stephen WM. Imaging pericardial disease. Radioloogic Clinics of North America 1989;27(6):1113-1125
4. Olson MC, Posniak HV, McDonald V, Siwniewski R, Moncada R. Computed tomography and magnetic resonance imaging of the pericardium. Radiographics 1989;9(4):633-649

Keywords

Pericardium, Non-infectious inflammation,