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Evaluation of the Pericardium with CT and MR.

Czum JM, Silas AM, Althoen MC - ISRN Cardiol (2014)

Bottom Line: The pericardium plays an important role in optimizing cardiac motion and chamber pressures and serves as a barrier to pathology.In addition to pericardial anatomy and function, this review article covers a variety of pericardial conditions, with mention of potential pitfalls encountered during interpretation of diagnostic imaging.Normal and abnormal appearance of pericardium on CT and MR imaging is emphasized, including dynamic imaging correlates of pericardial pathophysiology.

View Article: PubMed Central - PubMed

Affiliation: Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.

ABSTRACT
The pericardium plays an important role in optimizing cardiac motion and chamber pressures and serves as a barrier to pathology. In addition to pericardial anatomy and function, this review article covers a variety of pericardial conditions, with mention of potential pitfalls encountered during interpretation of diagnostic imaging. Normal and abnormal appearance of pericardium on CT and MR imaging is emphasized, including dynamic imaging correlates of pericardial pathophysiology.

No MeSH data available.


Related in: MedlinePlus

A 55-year-old previously healthy male with dyspnea. (a) Chest radiograph shows an enlarged cardiac silhouette, a right pleural effusion, and dilated azygos vein (arrow), (b) CECT demonstrates extensive venous collaterals around the heart, including prominent filling of (b) subcutaneous, (c) inferior phrenic, and (d) hepatic veins. (e) CECT shows a large pericardial effusion. The interventricular septum is flattened. The constellation of effusion, flat septum, and impaired venous return (b–d) is consistent with tamponade physiology. The patient's symptoms and blood pressure improved after pericardiocentesis. Fluid cytology was positive for malignant cells. He was later diagnosed with nonsmall cell lung cancer.
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fig3: A 55-year-old previously healthy male with dyspnea. (a) Chest radiograph shows an enlarged cardiac silhouette, a right pleural effusion, and dilated azygos vein (arrow), (b) CECT demonstrates extensive venous collaterals around the heart, including prominent filling of (b) subcutaneous, (c) inferior phrenic, and (d) hepatic veins. (e) CECT shows a large pericardial effusion. The interventricular septum is flattened. The constellation of effusion, flat septum, and impaired venous return (b–d) is consistent with tamponade physiology. The patient's symptoms and blood pressure improved after pericardiocentesis. Fluid cytology was positive for malignant cells. He was later diagnosed with nonsmall cell lung cancer.

Mentions: On dynamic imaging, ventricular interdependence is manifested by rocking motion of the interventricular septum during the cardiac cycle. Specifically, the septum moves toward the left ventricle in early diastole as the right ventricle fills with systemic blood resulting in a transient relative elevation of right heart pressure. The septum moves back toward the right ventricle only in late diastole as the pressure on the left eventually exceeds that of the right. With prolonged or severe tamponade, right ventricular filling becomes impaired as right ventricular end-diastolic pressure (and right atrial pressure) approaches central venous pressure. On imaging, this can be suspected if the contrast bolus refluxes into dilated hepatic veins or collateral vessels (Figure 3) [23]. The end-stage occurs with systemic and pulmonary venous pooling, resulting in equalization of chamber pressures and complete left ventricular diastolic failure [4, 20].


Evaluation of the Pericardium with CT and MR.

Czum JM, Silas AM, Althoen MC - ISRN Cardiol (2014)

A 55-year-old previously healthy male with dyspnea. (a) Chest radiograph shows an enlarged cardiac silhouette, a right pleural effusion, and dilated azygos vein (arrow), (b) CECT demonstrates extensive venous collaterals around the heart, including prominent filling of (b) subcutaneous, (c) inferior phrenic, and (d) hepatic veins. (e) CECT shows a large pericardial effusion. The interventricular septum is flattened. The constellation of effusion, flat septum, and impaired venous return (b–d) is consistent with tamponade physiology. The patient's symptoms and blood pressure improved after pericardiocentesis. Fluid cytology was positive for malignant cells. He was later diagnosed with nonsmall cell lung cancer.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3926415&req=5

fig3: A 55-year-old previously healthy male with dyspnea. (a) Chest radiograph shows an enlarged cardiac silhouette, a right pleural effusion, and dilated azygos vein (arrow), (b) CECT demonstrates extensive venous collaterals around the heart, including prominent filling of (b) subcutaneous, (c) inferior phrenic, and (d) hepatic veins. (e) CECT shows a large pericardial effusion. The interventricular septum is flattened. The constellation of effusion, flat septum, and impaired venous return (b–d) is consistent with tamponade physiology. The patient's symptoms and blood pressure improved after pericardiocentesis. Fluid cytology was positive for malignant cells. He was later diagnosed with nonsmall cell lung cancer.
Mentions: On dynamic imaging, ventricular interdependence is manifested by rocking motion of the interventricular septum during the cardiac cycle. Specifically, the septum moves toward the left ventricle in early diastole as the right ventricle fills with systemic blood resulting in a transient relative elevation of right heart pressure. The septum moves back toward the right ventricle only in late diastole as the pressure on the left eventually exceeds that of the right. With prolonged or severe tamponade, right ventricular filling becomes impaired as right ventricular end-diastolic pressure (and right atrial pressure) approaches central venous pressure. On imaging, this can be suspected if the contrast bolus refluxes into dilated hepatic veins or collateral vessels (Figure 3) [23]. The end-stage occurs with systemic and pulmonary venous pooling, resulting in equalization of chamber pressures and complete left ventricular diastolic failure [4, 20].

Bottom Line: The pericardium plays an important role in optimizing cardiac motion and chamber pressures and serves as a barrier to pathology.In addition to pericardial anatomy and function, this review article covers a variety of pericardial conditions, with mention of potential pitfalls encountered during interpretation of diagnostic imaging.Normal and abnormal appearance of pericardium on CT and MR imaging is emphasized, including dynamic imaging correlates of pericardial pathophysiology.

View Article: PubMed Central - PubMed

Affiliation: Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.

ABSTRACT
The pericardium plays an important role in optimizing cardiac motion and chamber pressures and serves as a barrier to pathology. In addition to pericardial anatomy and function, this review article covers a variety of pericardial conditions, with mention of potential pitfalls encountered during interpretation of diagnostic imaging. Normal and abnormal appearance of pericardium on CT and MR imaging is emphasized, including dynamic imaging correlates of pericardial pathophysiology.

No MeSH data available.


Related in: MedlinePlus