Constrictive pericarditis

Case contributed by Dr Matt A. Morgan

Presentation

History not provided.

Patient Data

Age: 55-60Y
Gender: Male
MRI

In this cine grid sequence, the pericardium is not sliding past the myocardium as expected.  This is shown by the lines extending through the pericardium and myocardium. They do not break at any point in the cardiac cycle.

(A septal bounce can also be seen)

MRI

Multiple annotated MRI images showing findings in constrictive pericarditis.

Case Discussion

Cardiac MRI can be useful for evaluation of constrictive pericarditis, through a combination of  anatomic and functional information. The functional component is critical because even though the classic threshold for thickened pericardium is >4 mm on CT and MRI, as many as 28% of cases with surgically proven constrictive pericarditis have a normal pericardial thickness (18% were normal on histologic examination).1

One of the main problems in constrictive pericarditis is the inability of the ventricles to expand in diastole (they are "constricted"). This can lead to the "septal bounce" seen on echocardiography and MRI. The grid sequence above can highlight the lack of a normal sliding movement of the pericardium, strongly suggesting constrictive pericarditis.2 Abnormal thickening of the pericardium, pericardial enhancement, and regions of confluence of the pericardium and myocardium (as seen on the above images) further suggest constrictive pericarditis.

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Case information

rID: 31695
Case created: 21st Oct 2014
Last edited: 19th Sep 2015
System: Cardiac
Inclusion in quiz mode: Included

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