22 Pericardial Disease on Computed Tomography and Magnetic Resonance

Imaging

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig CA 22-1 Pericardial effusion (simple). Contrast CT scan shows an effusion (*) with the same attenuation as water.15

Fig CA 22-2 Pericardial effusion (serosanguinous). Contrast CT scan shows a moderate-sized enhancing effusion (*).15

Fig CA 22-3 Pericardial effusion (nonhemorrhagic). Cine GRE image shows a high-signal-intensity effusion (*), consistent with nonhemorrhagic fluid.15

Fig CA 22-4 Pericardial effusion (hemorrhagic). Axial T1-weighted MR image shows an effusion with high signal intensity (*), suggestive of hemorrhage.15

• Fig CA 22-5 Constrictive pericarditis. Contrast CT scan shows pericardial thickening (arrows) in this patient, who presented with symptoms of heart failure after mediastinal irradiation for Hodgkin's lymphoma.15

• Fig CA 22-6 Constrictive pericarditis. Coronal T1-weighted MR image shows abnormally thickened pericardium (arrows) outlined by epicardial and mediastinal fat.15

• Fig CA 22-7 Constrictive pericarditis. Contrast CT shows dense pericardial calcification (arrows) in a patient with a history of hemopericardium.15

• Fig CA 22-8 Infectious pericarditis. Contrast CT scan shows enhancement of the pericardium (arrows), indicative of inflammation. Note the associated small pericardial effusion and large bilateral pleural effusions (P).15

• Fig CA 22-9 Infectious pericarditis. (A) T1-weighted MR image shows a crescent-shaped area of intermediate signal intensity (arrows) surrounding the ventricles, which indicates either pericardial thickening or effusion. (B) Contrast T1-weighted image with fat saturation shows marked thickening and enhancement of the pericardium (arrows), findings consistent with inflammation. There is also a moderate-sized pericardial effusion.15

• Fig CA 22-10 Pericardial cyst. Contrast CT scan shows a nonenhancing homogeneous mass (arrows) with the attenuation of water, located adjacent to the pulmonary artery.15

• Fig CA 22-11 Pericardial cyst. (A) T1-weighted contrast MR image shows a nonenhancing mass (*) of intermediate signal intensity adjacent to the main pulmonary artery. (B) On a T2-weighted image, the mass (*) has homogeneous high signal intensity.15

• Fig CA 22-12 Pericardial hematoma. (A) T1-weighted contrast image shows a nonenhancing mass of heterogeneous signal intensity (M) in the right atrioventricular groove. (B) Phase velocity-encoded cine image shows no blood blow in the mass (M), a finding indicative of hematoma rather than pseudoaneurysm.15

• Fig CA 22-13 Pericardial hematoma (chronic, organized). (A) T1-weighted MR image in a patient who had sustained blunt chest trauma 8 years previously shows a well-circumscribed mass (M) with intermediate signal intensity in the left atrioventricular groove that compresses the left atrium and ventricle. (B) Cine GRE image shows a mass (M) with low-signal-intensity foci and a low-signal-intensity rim (arrows), which are indicative of central and peripheral calcifications.15

• Fig CA 22-14 Metastatic lymphoma. Contrast CT scan shows a large heterogeneous anterior mediastinal mass (M) with central necrosis, which has invaded the pericardium (arrowheads). Note the moderate pericardial effusion (*) and associated enhancement of the pericardium.15

• Fig CA 22-15 Primary pericardial mesothelioma. Contrast CT scan shows a large pericardial effusion (*) and no pericardial nodules (which occur in this disease but are rare).15

• Fig CA 22-16 Primary pericardial lymphoma. Contrast CT scan shows an irregular, enhancing soft-tissue mass (*), which has infiltrated the entire pericardium.15

• Fig CA 22-17 Congenital absence of the pericardium. Contrast CT scan shows interposition of lung tissue between the aorta and the main segment of the pulmonary artery (arrow), indicating the absence of the pericardium in this area. Note the rotation of the heart toward the left.15