The pericardium and pericardial disease

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Transoesophageal Echocardiography ◽  
Pericardial Tamponade ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Mechanically Ventilated ◽  
Spectral Doppler ◽  
Echocardiographic Assessment

Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.

Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma

2016 ◽  
Author(s):  
Terrence D. Welch ◽  
Kyle W Klarich ◽  
Jae K. Oh
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Left Ventricular ◽  
Cardiac Tumors ◽  
Management Options ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Cardiac Trauma ◽  
Pulsed Wave Doppler

The pericardium consists of a fibrous sac and a serous membrane. Because of its simple structure, the clinical syndromes involving the pericardium are relatively few but vary substantially in severity. Cardiac tumors may be either primary or secondary and either benign or malignant, with attachment sites throughout the endocardium. Cardiovascular trauma should be suspected in all patients with chest injuries or severe generalized trauma. Cardiovascular injury may be either blunt or penetrating. This review covers pericardial disease, cardiac tumors, and cardiovascular trauma. Figures show an electrocardiogram in acute pericarditis; acute pericarditis with delayed gadolinium enhancement of the pericardium shown with cardiac magnetic resonance imaging; underlying cause of pericardial effusion requiring pericardiocentesis; pericardial pressure-volume curves; large pericardial effusion with swinging motion of the heart resulting in electrical alternans; typical pulsed-wave Doppler pattern of tamponade; underlying causes of constrictive pericarditis in patients undergoing pericardiectomy; pericardial calcification seen on a chest radiograph; thickened pericardium; typical pulsed-wave Doppler pattern of constrictive pericarditis; typical mitral annular tissue velocities in constrictive pericarditis; a diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis; simultaneous right ventricular and left ventricular pressure tracings in restrictive cardiomyopathy; computed tomographic scan showing inflammatory constrictive pericarditis; systolic and diastolic transesophageal echocardiographic images of a large left atrial myxoma attached to the atrial septum; a decision tree of management options for patients with suspected papillary; transesophageal echocardiographic examples of aortic valve, mitral valve, left ventricular outflow tract, and tricuspid valve papillary fibroelastomas; and transesophageal short-axis view of the descending thoracic aorta in a hypotensive patient after a motor vehicle accident. The table lists tamponade versus constriction versus restrictive cardiomyopathy. This review contains 18 highly rendered figures, 1 table, and 77 references.

Pericardial disease

2016 ◽  
Author(s):  
Bernard Paelinck ◽  
Aleksandar Lazarević ◽  
Pedro Gutierrez Fajardo
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Two Dimensional ◽  
Pericardial Disease ◽  
Pericardial Diseases

Echocardiography is the cornerstone for the diagnosis of pericardial disease. It is a portable technique allowing morphological and functional multimodality (M-mode, two-dimensional, Doppler, and tissue Doppler) imaging of pericardial disease. In addition, echocardiography is essential for differential diagnosis (pericardial effusion vs pleural effusion, constrictive pericarditis vs restrictive cardiomyopathy) and allows bedside guiding of pericardiocentesis. This chapter describes normal pericardial anatomy and reviews echocardiographic features of different pericardial diseases and their pathophysiology, including pericarditis, pericardial effusion, constrictive pericarditis, pericardial cyst, and congenital absence of pericardium.

Pericardial diseases

2012 ◽  
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Tuberculous Pericarditis ◽  
Pericardial Diseases ◽  
Effusive Constrictive Pericarditis

Aetiology 460Syndromes of pericardial disease 461Acute pericarditis without effusion 461Pericardial effusion with or without tamponade 462Constrictive pericarditis 464Effusive-constrictive pericarditis 465Calcific pericarditis without constriction 465Viral pericarditis 466Tuberculous pericarditis 468Uraemic pericarditis 469Neoplastic pericardial disease 470Myxoedematous effusion ...

Pericardial Diseases

2018 ◽  
Author(s):  
David W. Schoenfeld
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Constrictive Pericarditis ◽  
Incidental Finding ◽  
Systemic Disease ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Pericardial Cavity ◽  
Pericardial Diseases ◽  
Wide Range

Diseases of the pericardium represent a wide range of clinical syndromes that vary substantially in severity, from a benign pericardial effusion to fatal constrictive pericarditis or hemopericardium. Acute pericarditis is the most common pericardial disease, with viral and idiopathic as the most frequent etiologies. Typically, acute pericarditis can be managed as an outpatient with dual-agent therapy consisting of aspirin or nonsteroidal anti-inflammatory drug plus colchicine and rarely requires admission. Pericardial effusions are fluid collections in the pericardial cavity. They are a common incidental finding, can be associated with other systemic disease, and at their extreme, cause life-threatening cardiac tamponade. Cardiac tamponade exists on a spectrum with patients who are quasi stable to those where cardiovascular collapse and death are imminent. Cardiac tamponade may be temporized with fluid boluses, but treatment is through pericardiocentesis and occasional surgical intervention. Constrictive pericarditis is progressive process with poor prognosis in which the pericardium becomes rigid and causes diastolic dysfunction, leading to heart failure. Once the diagnosis is made, definitive management is surgical but carries a high operative risk. This review contains 7 highly rendered figures, 5 videos, 3 tables, and 42 references. Key Words: cardiac tamponade, constrictive pericarditis, effusive-constrictive pericarditis, pericardial effusion, pericarditis, pericardiocentesis

scholarly journals 1095 Effective image-guided medical management in effusive constrictive pericarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Montes ◽  
A Cecconi ◽  
T Alvarado ◽  
A Vera ◽  
A Barrios ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Medical Treatment ◽  
Constrictive Pericarditis ◽  
Pericardial Fluid ◽  
Pericardial Window ◽  
Acute Pericarditis ◽  
Intravenous Corticosteroid ◽  
Persistent Inflammation ◽  
High Doses ◽  
Effusive Constrictive Pericarditis

Abstract A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started. During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition. Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D). Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis. Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery. Abstract 1095 Figure.

scholarly journals 639 A case of acute transient constrictive pericarditis—an unusual presentation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Paolo Marco Pietro Spissu ◽  
Simone Angius ◽  
Maria Francesca Marchetti ◽  
Ludovica Caggiari ◽  
Alessandra Gioi ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Vena Cava ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Acute Pericarditis ◽  
Echocardiographic Examination ◽  
Mild Reduction ◽  
Chest X Ray ◽  
Anti Inflammatory

Abstract Aims Transient constrictive pericarditis (TCP) is a rare manifestation which can occur in up to 15% of cases of acute pericarditis and most have resolution after 3 months of anti-inflammatory therapy. Methods and results We present the case of a young guy who showed up at our emergency department complaining of pericarditic chest pain and fever up to 39 °C degrees since the previous 4 days. After physical examination, electrocardiogram, blood tests, chest X-ray, and echocardiography acute pericarditis with severe pericardial effusion (more than 20 mm of thickness) were diagnosed and an empiric anti-inflammatory therapy with ibuprofen and colchicine was started. After 2 weeks of therapy, patient was not clinically improving with a worsened pericardial effusion and only a mild reduction of inflammatory markers. During an echocardiographic examination, features of constrictive physiology were discovered: respirophasic interventricular septal shift, increased respiratory variation of the mitral and tricuspidal inflow, plethoric inferior vena cava, and ‘annulus reversus’ and ‘annulus paradoxus’ on Tissue Doppler Imaging (TDI). Cardiac magnetic resonance (CMR) was also performed to confirm the diagnosis of acute pericardial constriction: it revealed increased T2-weighted imaging signal and increased Delayed Gadolinium Enhanced (DGE) signal, respectively consistent with oedema and with neovascularization, both suggestive of acute pericardial inflammation. Therefore, oral low doses corticosteroid was started After 2 weeks course of ‘triple therapy’ the patient was clinically improved and the echocardiographic features of constrictive physiology were no longer present thus allowing his discharge and the continuation of therapy at home. Conclusions This case was remarkable because it showed that constrictive pericarditis may present in a reversible form with medical therapy, this meaning it is due to pericardial oedema, inflammation and fibrin deposition similar to acute pericarditis rather than the pericardial fibrosis and calcification more commonly seen in chronic pericardial constriction.

Pericardial disease

2011 ◽  
Author(s):  
Bernard Cosyns ◽  
Bernard Paelinck
Keyword(s):  
Differential Diagnosis ◽  
Pericardial Effusion ◽  
Diagnostic Method ◽  
Multimodality Imaging ◽  
Restrictive Cardiomyopathy ◽  
Definitive Diagnosis ◽  
Pericardial Disease ◽  
Non Invasive ◽  
Appropriate Treatment ◽  
Structural Abnormalities

The ability of ultrasound to elucidate the functional and structural abnormalities of pericardial disease is powerful. Due to multimodality imaging possibilities and to its portability, echocardiography is the technique of choice for the diagnosis of pericardial disease. Although other non-invasive technologies have been developed to provide information about the pericardium, echocardiography remains the first and often only diagnostic method needed to make a definitive diagnosis and guide appropriate treatment in patients with pericardial effusion, cardiac tamponade, or constrictive pericarditis. It allows differential diagnosis with restrictive cardiomyopathy and can easily be performed for guiding pericardiocentesis.

scholarly journals Constrictive pericarditis after heart transplantation: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-6
Author(s):  
Vincent Tchana-Sato ◽  
Arnaud Ancion ◽  
François Ansart ◽  
Jean Olivier Defraigne
Keyword(s):  
Heart Failure ◽  
Pericardial Effusion ◽  
Heart Transplantation ◽  
Constrictive Pericarditis ◽  
Rare Complication ◽  
Volume Overload ◽  
Restrictive Cardiomyopathy ◽  
Right Heart Failure ◽  
Clinical Problem ◽  
Idiopathic Dilated Cardiomyopathy

Abstract Background Constrictive pericarditis (CP) is a disease characterized by inflammation, progressive fibrosis, and thickening of the pericardium. Constrictive pericarditis after heart transplantation (HT) is a rare phenomenon, with a reported incidence of 1.4–3.9%. It is an important clinical problem which shares similar clinical features with entities such as restrictive cardiomyopathy. Therefore, it poses diagnostic challenges and therapeutic dilemmas even for experienced clinicians. Case summary A 53-year-old patient developed a zoster infection with pericardial effusion 9 months after HT for idiopathic dilated cardiomyopathy. Two months later, he presented with leg oedema and ascites and was treated by diuretics for volume overload. He was readmitted 8 months later with features of right heart failure. Multimodal imaging investigations were suggestive of CP. He successfully recovered after a radical pericardiectomy. Discussion Constrictive pericarditis is a rare complication in HT. Heart transplant recipients (HTR) with a history of post-operative pericardial effusion, or with rejection episodes are at high risk of developing CP. Differentiating CP from other conditions that cause apparent congestive heart failure in HTR is challenging. Management of CP is mainly surgical pericardiectomy.

scholarly journals Pediatric COVID-19 and Pericarditis Presenting With Acute Pericardial Tamponade

2020 ◽  
Vol 11 (6) ◽  
pp. 802-804
Author(s):  
Tia T. Raymond ◽  
Ashima Das ◽  
Shai Manzuri ◽  
Stuart Ehrett ◽  
Kristine Guleserian ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pericardial Effusion ◽  
Inflammatory Markers ◽  
Pericardial Tamponade ◽  
Acute Pericarditis ◽  
At Home

We describe a seven-year-old female with acute pericarditis presenting with pericardial tamponade, who screened positive for coronavirus disease 2019 (COVID-19 [SARS-CoV-2]) in the setting of cough, chest pain, and orthopnea. She required emergent pericardiocentesis. Due to continued chest pain and orthopnea, rising inflammatory markers, and worsening pericardial inflammation, she underwent surgical pericardial decortication and pericardiectomy. Her symptoms and pericardial effusion resolved, and she was discharged to home 3 days later on ibuprofen and colchicine with instruction to quarantine at home for 14 days from the date of her positive testing for COVID-19.

Overview of pericardial syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1561-1563
Author(s):  
Michael Arad ◽  
Yehuda Adler
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pericardial Effusion ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Pericardial Diseases ◽  
Pericardial Syndromes ◽  
Work Up ◽  
Systemic Condition ◽  
Symptoms And Signs

Pericardial diseases manifest as a part of a systemic condition or in isolation. The clinical presentation is driven by inflammation (i.e. pericarditis), excess fluid accumulation (pericardial effusion), or pericardial stiffening (constriction). Corresponding symptoms and signs may include pain, stigmata of systemic inflammation, atrial arrhythmia, haemodynamic compromise, or chronic heart failure. Pericardial tumours and space-occupying lesions are uncommon and may be incidentally detected or present as one of the above-mentioned forms of pericardial disease. Aetiological work-up is usually unnecessary in acute pericarditis but is indicated in the incessant/chronic form and to exclude bacterial infection. Pericardial effusions need to be investigated when large and promptly evacuated when associated with haemodynamic compromise. The hallmark of constrictive physiology is ventricular interdependence. It is important to distinguish transient constriction and to treat inflammation according to aetiology prior to making a decision on surgical relief by pericardiectomy.

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