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Weekly Chest CasesArchive of Old Cases

Case No : 960 Date 2016-03-21

  • Courtesy of Jung Eun Lee, Yoon Ki Cha, Jeung Sook Kim / Dongguk University Ilsan Hospital
  • Age/Sex 83 / M
  • Chief ComplaintGeneral weakness with dyspnea
  • Figure 1
  • Figure 2

Diagnosis With Brief Discussion

Diagnosis
Constrictive pericarditis
Radiologic Findings
Chest PA (Fig 1) and lateral (Fig 2) show dense irregular rim-like calcification in the heart along the ventricular chambers. Mediastinal window setting images of non-contrast enhanced chest CT (Fig 3-5) also show dense irregular calcification in the pericardium along both ventricular chambers including the atrioventricular groove. Enlargement of both ventricles is not definite.
Brief Review
Constrictive pericarditis is characterized by fibrous or calcified constrictive thickening of the pericardium, which prevents normal diastolic ventricular expansion. There are several causes of constrictive pericarditis including cardiac surgery, radiation therapy, infection (viral or tuberculous), connective tissue disease, and neoplasm.
Clinically, it is difficult to differentiate between constrictive pericarditis and restrictive cardiomyopathy because of similar clinical manifestations and similar findings at cardiac catheterization and echocardiography. However, it is important to distinguish between the two different disease entities, because constrictive pericarditis is potentially curable by pericardiectomy.
On chest radiographs, constrictive pericarditis shows calcification in the pericardium in roughly 50% of patients. The diagnosis of constrictive pericarditis is greatly aided by CT and MR imaging. Normal pericardial thickness (less than 2 mm) on CT and MRI images can exclude constrictive pericarditis even in patients with symptoms and signs suggestive of constrictive pericarditis. The CT and MRI image findings of constrictive pericarditis include pericardial thickening (greater than 4 mm), narrowing and tubular deformity of the right ventricle, normal or small ventricular size, and straightening of the interventricular septum. 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 (such as in the atrioventricular groove). Systemic venous dilatation (particularly in the inferior vena cava), hepatomegaly, ascites, and pleural effusion are also frequently seen.
References
1. J.S. Kim, H.H. Kim, Y. Yoon. Imaging of pericardial diseases. Clin Radiol 2007; 62:626-631.
2. Wang ZF, Reddy GP, Gotway MB, et al. CT and MR imaging of pericardial disease. RadioGraphics 2003; 23:S167-S180.
3. Jan Bogaert, Marco Francone, Pericardial disease: Value of CT and MR imaging. Radiology 2013; 267:340-356.
Keywords
Pericardium, Non-infectious inflammation,

No. of Applicants : 114

▶ Correct Answer : 46/114,  40.4%
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - PRINCE ALI KHAN HOSPITAL , India FAHAD LODHIA
  • - Kyoto University , Japan Akihiko Sakata
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - Jangsung public clinic , Korea (South) YongSub Song
  • - Kyungpook national university hospital, Korea , Korea (South) SUNGJUN MOON
  • - Human medical imaging % intervention center , Korea (South) Suryoung Jun
  • - istituti ospitalieri di cremona , Italy pietro sergio
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Pusan national university hospital , Korea (South) hie bum suh
  • - Himeji Redcross Hospital , Japan Soichiro Okamoto
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - privato , Italy genchi enzo
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - GHICL , France manuel toledano
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Kwandong University College of Medicine Myongji Hospital , Korea (South) So Young Heo
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Asan Medical Center , Korea (South) Ji Ye Lee
  • - Korea University Guro Hospital , Korea (South) Hwanseok Yong
  • - Chonnam national university hospital , Korea (South) Kim go eun
  • - Niigata University , Japan Atsushi Uehara
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Chungbuk national university , Korea (South) Yong Kim
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - Chung buk national university hospital , Korea (South) hong Byun
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - Sam Anyang HOSPITAL , Korea (South) HA JONG SU
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Private sector , Greece Vasilios Tzilas
  • - okayama university , Japan numa shingo
  • - Chonnam Nationl University Radiology , Korea (South) juwon kim
  • - Himeji Red Cross Hospital , Japan Mayu Uka
  • - Pusan National University Hospital , Korea (South) LEE YOU JIN
  • - Medicheck health care , Korea (South) Chae Lim
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Tokyo university, Japan , Japan Nomura Hiromi
▶ Correct Answer as Differential Diagnosis : 27/114,  23.7%
  • - chosun university hospital , Korea (South) Eunju Yoon
  • - Nihon University Itabashi Hospital , Japan Yusuke Watanabe
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
  • - Tianjin medical university , India Mohammed Khalid
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Ulsan University Hospital , Korea (South) Soyeoun Lim
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - 異⑸ , Korea (South) Junghwan Kim
  • - Wonju Severance Christian Hospital , Korea (South) SANGA LEE
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Les cedres St malo , France nicolas gautier
  • - Saint Malo , France jean-baptiste Noel
  • - NASA SCANS , India RAKESH BHATIA
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Pusan national university hospital , Korea (South) MIRI JEONG
  • - Pusan national university hospital , Korea (South) So Park
  • - PNUH , Korea (South) Seungbaek Hong
  • - Chonnam national university hospital , Korea (South) Gunsoo Kim
  • - NEUROCITI DIAGNOSTICS , India Justin Moses
  • - Pusan National University Hospital , Korea (South) Jeong Park
▶ Semi-Correct Answer : 1/114,  0.9%
  • - CHU Poitiers , France CHAN paul
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