Constrictive pericarditis cp is a potentially curable cause of diastolic heart failure. Constrictive pericarditis is the end result of subacute and chronic inflammation of the pericardium, with subsequent haemodynamic effects due to the mechanical constriction that impedes chamber filling. Patients with restrictive cardiomyopathies and constrictive pericarditis are often excluded or underrepresented in large randomized clinical trials. The etiological factors of constrictive pericarditis are many with tuberculosis being one of the commonest causes. Clinical presentation is dominated by restricted diastolic. Biatrial enlargement with minimal or no ventricular enlargement may be present. Calcification is seen in 12 of patients with constrictive pericarditis its presence does not imply constriction pericardial calcification must be differentiated from coronary artery calcification, valvular calcification, calcified myocardial infarct or ventricular aneurysm, left atrial calcification, or calcification outside the heart. The pericardium is the saclike membrane that surrounds the heart. The diagnosis of cp requires a high degree of clinical suspicion. Discrimination of the pericardium from the myocardium on radiologic images requires the presence of epicardial fat or pericardial fluid. Signs and symptoms of constrictive pericarditis are. Restrictive cardiomyopathy rcm is a form of cardiomyopathy in which the walls of the heart are rigid but not thickened. Although many diagnostic criteria for constrictive pericarditis have been proposed, this diagnosis continues to be a clinical. Mar, 2017 constrictive pericarditis cp is a relatively uncommon form of clinical heart failure.
Diagnosis of constrictive pericarditis with multimodality imaging. At times, a calcified pericardium is seen with encasement of the heart impeding diastolic filling 1. Defined by thickening of pericardium 4mm impeding diastolic filling. The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. Surgical pericardiectomy has the ability to cure cp, with dramatic improvements. Constrictive pericarditis is a rare condition which occurs when a thick, inelastic pericardium encases the heart and restricts expansion, resulting in chronic biventricular diastolic dysfunction, predominant right heart failure, and low systemic output. Constrictive pericarditis symptoms and ecg medical library. Fischbein and colleagues relating constrictive pericardial physiology to calcified pericarditis associated with asbestos exposure chest 1988.
The diagnosis of constrictive pericarditis cp generally requires both the demonstration of an appropriate physiology and evidence of pericardial thickening. When the etiology is prior inflammation tuberculosis being the classic example, pericardial calcification is often detected. Learningradiology pericardial calcifications, constrictive. Mri plays an important role in the morphologic and functional evaluation of pericardial diseases. The sensitivity, specificity, and accuracy of mr imaging in the diagnosis of constrictive pericarditis were 88%, 100%, and 93%, respectively. A physical exam may show that your neck veins stick out. In constrictive pericarditis, 2dimensional echocardiography is used mainly to rule out other causes of rightsided heart failure. A problembased learning approach apos clinical reference handbooks cases in radiology.
The scarred, and noncompliant pericardium causes restraint to early diastolic ventricular filling, resulting in the equalisation of intracardiac diastolic filling pressures, producing the socalled single diastolic chamber. Pericardial calcifications constrictive pericarditis. No single demographic is affected as there are numerous causes of constrictive pericarditis. Chest radiograph signs suggestive of pericardial disease. In the embedded ct image, the white arrows indicate the calcifications in the pericardium at midventricular level. Although pericardial disease often represents a diagnostic challenge, ct and mr imaging. Longterm outcomes of pericardiectomy for constrictive. The clinical aspects of pericardial disease encompass acute pericarditis. Online learning catalog understanding moc products and resources. Constrictive pericarditis radiology reference article. Tuberculous pericarditis is the entity in which inflammation of the.
This limits diastolic relaxation of the heart and causes congestive heart. We exploited the clinical potential of novel realtime cine sequences to study the effects of. Signs and symptoms are similar to other conditions such as restrictive cardiomyopathy and cardiac tamponade. Constrictive pericarditis remained idiopathic in six patients 54. Pericardial diseases guidelines on the diagnosis and management of. The thickness of the normal pericardium, measured on ct scans and on mr images, is less than 2 mm,, fig 1, 8, 9. In the developing world tuberculosis is a common cause of constrictive pericarditis. The symptoms of cp appear insidiously, with patients displaying peripheral edema, anasarca, and elevated rightsided heart pressures.
Risk factors for the development of cp include prior cardiac surgery and radiation therapy. The case highlights the need to integrate all information, including clinical data, noninvasive cardiac imaging, and even invasive hemodynamic. Constrictive pericarditis medical video learn pathology. All patients were symptomatic, presenting with variable degrees of dyspnea and right heart failure symptoms. Epidemiology no single demographic is affected as there.
In effusive constrictive pericarditis, there is both thickening of the pericardium with adhesions to the epicardium as well as loculated pericardial effusions. Thickened pericardium was observed in 88% of patients with proved constrictive pericarditis. The pathophysiology of constrictive pericarditis is restriction of diastolic ventricular filling due to a noncompliant pericardium which is often adhered to the epicardium. Noninvasive multimodality imaging for the diagnosis of constrictive. This leads to impairment of ventricular filling in mid and late diastole. A recent study reported that response to antiinflammatory therapy is more likely to occur in patients with evidence of significant pericardial late enhancement and increased creactive protein.
Mar 19, 2020 constrictive pericarditis is often iatrogenic following openheart surgery or radiation therapy for the treatment of mastocarcinoma and other cancers. Cardiac mri is useful for differentiating between constrictive pericarditis. Conversely 2750% of patients with constrictive pericarditis have pericardial. Discrimination of the pericardium from the myocardium on radiologic images requires the presence of epicardial fat or. Pathophysiology and diagnosis of constrictive pericarditis. Constrictive pericarditis was first described in the literature by white in 1935 and subsequently its surgical treatment was discussed.
As a result, the majority of ventricular filling occurs rapidly in early diastole and the ventricular volume does not increase after the end of the. Nov 27, 2015 constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Chronic constrictive pericarditis ccp is not rare in africa with tuberculosis as the most common etiology. Not only the clinical presentation may be atypical, mimicking other. Echocardiography is an essential diagnostic modality in patients with suspected pericardial constriction. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. Constrictive pericarditis constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. The visceral pericardium is a mesothelial monolayer that is adherent to the epicardium, which is reflected back on itself at the level of the great vessels. Cardiac radiology genitourinary radiology learning radiology. Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Constrictive pericarditis or perhaps better termed pericardial constriction is a type of pericarditis which leads to diastolic dysfunction and potentially symptoms of right heart failure. This ssfp cine from a patient with constrictive pericarditis shows a diastolic septal bounce in the interventricular septum as well as biatrial enlargement. Your health care provider will need to rule out these conditions when making a diagnosis. Use of magnetic resonance imaging in assessment of.
Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. Constrictive pericarditis prevalence, causes and clinical. Management of pericardial disease eyal herzog springer. Constrictive pericarditis cp is a relatively uncommon form of clinical heart failure. Imaging in constrictive pericarditis jagia p, kumar k j. Narula s, shameer k, salem omar am, dudley jt, sengupta pp. The purpose of this study was to evaluate the longterm outcomes following treatment of constrictive pericarditis by pericardiectomy. Readers must therefore always check the product information.
Pdf chronic constrictive pericarditis researchgate. Transient constrictive pericarditis due to postpericardiotomy syndrome, tuberculous, or viral pericarditis may respond to antiinflammatory therapy. Constrictive pericarditis calcification in the pericardium is most likely inflammatory in nature can be seen with a variety of infections, trauma, and neoplasms. Panel a rao 30 view showing an enddiastolic view of the left ventricle. Ct and mr imaging of pericardial disease radiographics. Diagnosis of constrictive pericarditis by tagged cine magnetic resonance imaging.
Constrictive pericarditis and restrictive cardiomyopathy. The symptoms of cp, which may include exercise intolerance, liver failure, dyspnea, and renal failure, appear insidiously and may be misleading. Jan 01, 2020 talreja dr, nishimura ra, oh jk, holmes dr. Constrictive pericarditis is the result of abnormal pericardial compliance, which in the majority of instances is associated with a thickened pericardium. Constrictive pericarditis cp is a form of diastolic heart failure that arises because an inelastic pericardium inhibits cardiac filling. Constrictive pericarditis is an uncommon disease in children, usually difficult to diagnose. Constrictive pericarditis or perhaps better termed pericardial constriction is a type of pericarditis which leads to diastolic dysfunction and potential symptoms of right heart failure. Esc guidelines on pericardial diseases diagnosis and. Thickened pericardium may calcify 50% calcified pericardium almost always implies constriction, but not always. In patients with severe constrictive pericarditis, classic findings include an unusual early diastolic septal bounce and an inspiratory septal shift see discussion later in mri section. New cardiac imaging algorithms to diagnose constrictive.
Constrictive pericarditis definition of constrictive. Constrictive pericarditis cp is a reduction in the elasticity, or stiffening, of the pericardium, a sacklike covering that surrounds the heart, resulting in impaired filling of the heart with blood. Diagnostic value of chest radiography for pericardial effusion. Panel c simultaneous pressure tracings of the left and right. Constrictive pericarditis and its differential diagnosis from restrictive cardiomyopathy are presented. Apr 12, 2017 the first study to evaluate the role of automated machine learning algorithms in differential diagnosis of constrictive pericarditis and restrictive cardiomyopathy. Recurrent pericardial inflammation may result in constrictive pericarditis. Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively examined. Constrictive pericarditis can be caused by any of the disorders that affect the pericardium shown in box 9.
It is the least common of the three original subtypes of cardiomyopathy. Constrictive pericarditis occurs when scarring and calcification of the pericardium result in loss of normal elasticity. Pdf cognitive machinelearning algorithm for cardiac. Occult constrictive pericarditis chest pain, dyspnea fatigue reported in 1977 described 19 patients with a syndrome called occult constrictive pericardial disease 10. Access to the complete content on oxford medicine online requires a subscription or purchase. Thus the heart is restricted from stretching and filling with blood properly. Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. Constrictive pericarditis associated with patch electrodes of the automatic implantable cardioverterdefibrillator. Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively. Apr 29, 2016 constrictive pericarditis is the result of abnormal pericardial compliance, which in the majority of instances is associated with a thickened pericardium. Treatments for pericarditis, constrictive constrictive pericarditis include.
Tb, recurrent pericarditis, hx of heart surgery constrictive pericarditis sarcoid, amyloid, hemochromatosis restrictive cardiomyopathy radiation injury can be either exam. Restrictive cardiomyopathy radiology reference article. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. On t 1weighted spinecho mr imaging, the normal pericardium is identified as a thin band of low signal intensity, owing to its mainly fibrous structure, bordered by the high signal intensities of the external pericardial fat and the internal epicardial fat. Antibiotics, painrelieving medication, diuretics to remove excess fluid, nsaids or corticosteroids to alleviate inflammation, pericardiocentesis, surgical removal of part of pericardium in recurring or chronic cases.
Ct and mr imaging provide excellent visualization of the pericardium in most patients, 6, 7. Constrictive pericarditis radiology reference article radiopaedia. About 50% of calcified pericardiums are visible on conventional radiography. Constrictive pericarditis is very hard to diagnose. This axial ct image of the chest is displayed using bone windows to show the calcifications of the pericardium red arrows. Constrictive pericarditis cp is a rare clinical entity that can pose diagnostic problems. We present the case of a 14yearold boy with a previous history of tuberculosis and right heart failure, in whom constrictive pericarditis was diagnosed. Constrictive pericarditis is longterm, or chronic, inflammation of the pericardium. Cardiovascular magnetic resonance in pericardial diseases. Journal of the practice of cardiovascular sciences,india. Constrictive pericarditis or perhaps better termed pericardial constriction is a type of pericarditis which leads to diastolic dysfunction and potential symptoms of.
Constrictive pericarditis versus restrictive cardiomyopathy. Constrictive pericarditis cp is an increasingly recognised disease with various causes characterised by a fibrotic, thickened. Both constrictive pericarditis and pericardial thickening can results from tuberculosis, radiation, viral pericarditis, or prior surgery. Inflammatory heart diseases are characterized as focal, diffuse, or sparse inflammatory processes of the myocardium and its adjacent structures, including pericardium and endocardium. Constrictive pericarditis an overview sciencedirect topics. The pathophysiologic characteristics of the various pericardial syndromes can be studied with different imaging modalities, but it is. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. Differential diagnosis in pericardial disease remains difficult and challenging to the clinician. Panel b 3d ct images of the heart indicating the presence of dense calcium at midventricular level and sparing the apical region blue arrows. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constrictive pericarditis. A 38yearold man was hospitalized for cardiac catheterization.
Machine learning algorithms to automate morphological and functional assessments in 2d echocardiography. On echocardiographic data, thick pericardium was suspected in five 45. Radiationinduced constrictive pericarditis usually presents 10 years after therapy. This disorder must be considered in the differential diagnosis for unexplained heart failure, particularly when the left ventricular ejection fraction is preserved. The diagnostic accuracy of mri in constrictive pericarditis in patients with symptoms and signs suggestive of the diagnosis exceeds 90%. Echocardiography is the mainstay in the diagnostic evaluation of constrictive pericarditis cp and restrictive cardiomyopathy rcm, but no single echocardiographic parameter is sufficiently robust to accurately distinguish between the two conditions.
Constrictive pericarditis cp is a recognised, but unusual cause of chronic ascites. Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Aug 01, 2018 constrictive pericarditis is a reduction in the elasticity, or stiffening, of the pericardium, a sacklike covering that surrounds the heart, resulting in impaired filling of the heart with blood. In african setting, frequent radiographical findings at chest xray are as follows. Constrictive pericarditis was verified by means of surgery andor catheterization in 17 patients. Calcification in the pericardium is most likely inflammatory in nature. The most sensitive sign for a pericardial effusion on cxr is enlargement of the cardiac. There are bilateral pleural effusions present white arrows, a common finding in constrictive pericarditis. A correct diagnosis is difficult to establish on clinical grounds alone. Constrictive pericarditis is often iatrogenic following openheart surgery or radiation therapy for the treatment of mastocarcinoma and other cancers. Jul 29, 2014 constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. Good knowledge of the pathophysiology and experienced management is in the best interest of the patient.
1350 430 645 54 681 45 1290 1460 1653 631 78 231 56 743 628 576 61 1099 1153 325 1224 1292 870 468 625 261 1264 473 613 259 198