A Case of Effusive-Constrictive Pericarditis: An Efficacy of Gd-DTPA Enhanced Magnetic Resonance Imaging to Detect a Pericardial Thickening

Abstract Background Right ventricular diverticula (RVD) are very rare congenital anomalies and their association with constrictive pericarditis is even rarer. So far, only one case has been published in literature. Case summary We report a case of multiple congenital RVD with constrictive pericarditis and right heart failure which was incidentally identified on surveillance computed tomography (CT) for abdominal lymphangioma. Interval CT, echocardiography, and cardiac magnetic resonance imaging (CMR) studies were performed and reviewed. Computed tomography abdomen showed hepatic congestion with features of portal hypertension, increasing size of the RVD on review of serial CTs, and eccentric foci of pericardial calcification. Echocardiography performed for breathlessness demonstrated supranormal early diastolic tissue velocities with average of 19.8 cms−1 and a septal bounce phenomenon on m-mode imaging suggesting constrictive physiology, which triggered a CMR referral. Cardiac magnetic resonance imaging HASTE and right ventricular (RV) outflow tract imaging showed four outpouchings along RV free wall, the largest measuring 4.5 × 2 cm with a sizeable neck. These outpouchings displayed a trabecular network and/or were contractile aiding the diagnosis of diverticula as opposed to aneurysms. Right ventricular function was moderately compromised, whereas left ventricular function was preserved. Discussion Right ventricular diverticula can be associated with, and potentially be causative of, pericardial thickening and calcification eventually leading to constrictive pericarditis and heart failure.

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Radionuclide angiography and magnetic resonance imaging: complementary non-invasive methods in the diagnosis of constrictive pericarditis

European Journal of Nuclear Medicine ◽

10.1007/bf00801616 ◽

1995 ◽

Vol 22 (11) ◽

pp. 1292-1298 ◽

Cited By ~ 5

Author(s):

A. Furber ◽

P. P�zard ◽

J. J. Le Jeune ◽

P. Geslin ◽

A. Tadei ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Constrictive Pericarditis ◽

Radionuclide Angiography ◽

Resonance Imaging ◽

Non Invasive

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Imaging Features of Constrictive Pericarditis: Beyond Pericardial Thickening

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2009.02.034 ◽

2009 ◽

Vol 60 (1) ◽

pp. 40-46 ◽

Cited By ~ 9

Author(s):

Giuseppe Napolitano ◽

Josephine Pressacco ◽

Eleonore Paquet

Keyword(s):

Magnetic Resonance Imaging ◽

Constrictive Pericarditis ◽

Clinical Suspicion ◽

Diastolic Filling ◽

Diagnostic Feature ◽

Imaging Features ◽

Imaging Findings ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Pericardial Thickening

Constrictive pericarditis is caused by adhesions between the visceral and parietal layers of the pericardium and progressive pericardial fibrosis that restricts diastolic filling of the heart. Later on, the thickened pericardium may calcify. Despite a better understanding of the pathophysiologic basis of the imaging findings in constrictive pericarditis and the recent advent of magnetic resonance imaging (MRI) technology, which has dramatically improved the visualization of the pericardium, the diagnosis of constrictive pericarditis remains a challenge in many cases. In patients with clinical suspicion of underlying constrictive pericarditis, the most important radiologic diagnostic feature is abnormal pericardial thickening, which can be shown readily by computed tomography (CT) and especially by MRI, and is highly suggestive of constrictive pericarditis. Nevertheless, a thickened pericardium does not always indicate constrictive pericarditis. Furthermore, constrictive pericarditis can occur without pericardial thickening.

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