Presentation
Shortness of breath.
Patient Data
"Bullet-shaped" ventricles, enlarged atria and a "septal bounce" are findings suspicious for constrictive pericarditis.
In addition to the image stacks, there are two sets of cine-image video sequences for each plane: the first has a frame rate of 30 frames per second, and the second is set to 15 frames per second, making the septal bounce easier to recognize.
Case Discussion
A septal bounce can occur for various reasons 1: one is the altered physiology in constrictive pericarditis, which is the most probable etiology for the paradoxical septal motion in this case.
Normally, when the atria contract during diastole, blood flows into the ventricles, free to expand outwards within the pericardium.
However, with pericardial constriction, the ventricles cannot expand. During diastole, the right atrium contracts first because the sinoatrial node is in the right atrium. This causes the right ventricle to fill before the left ventricle.
In the presence of pericardial constriction, the right ventricle cannot expand outwards: as it fills, during early diastole, the right ventricle pushes the septum towards the left ventricle. Later in diastole, left ventricular filling pushes the septum back to the right ventricle, resulting in the to-and-fro septal bounce.
The cine images in this case were obtained while the patient held his breath. The septal bounce is even more pronounced in inspiration: negative intrathoracic pressure draws more blood into the chest and ultimately into the right atrium and ventricle.
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