Constrictive pericarditis

Case contributed by Dr Prashant Gupta

Presentation

Case of Carcinoma left breast (post operative and post radiotherapy) with features of heart failure

Patient Data

Age: 40
Gender: Female
CT

There is diffuse thickening of the anterior pericardium, upto the vascular root, best seen in multiplanar reformat images. Indentation of right ventricle is seen, causing a "tubular" configuration.

Post-op changes are seen in left chest wall.

The IVC is dilated to more than double the aortic diameter

Case Discussion

This case depicts CT findings of constrictive pericarditis.

Common causes of constrictive pericarditis include injury, infection, radiotherapy. Radiotherapy is most likely cause in this patient.

CT/MRI can aid in diagnosis, as clinically constrictive pericarditisand restrictive cardiomyopathy are similar. CT shows thickening (>4mm) of pericardium, most commonly in anterior portion

It should however, be accompanied by clinical signs of heart failure. Imaging signs that suggest heart failure (especially right heart) are: dilated RA, dilated hepatic veins, dilated IVC to more than twice aortic diameter, periportal edema, enlarged SVC > adjacent aorta, reflux of contrast into IVC and distal hepatic veins (proximal reflux can be seen with high flow rates).

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Case information

rID: 18006
Case created: 31st May 2012
Last edited: 19th Jul 2017
System: Chest
Inclusion in quiz mode: Included

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