Diagnostic role of computed tomography in pericardial heart disease: Congenital defects, thickening, neoplasms, and effusions

Moncada, Rogelio; Baker, Mark E.; Salinas, Matias; Demos, Terrence C; Churchill, Robert; Love, Leon; Reynes, Carlos J.; Hale, David J.; Cardoso, M. Jorge; Pifarré, Roque; Gunnar, Rolf M.

doi:10.1016/0002-8703(82)90499-9

Cited by 135 publications

(32 citation statements)

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“…Constrictive pericarditis was diagnosed by chest roentgenography (calcified pericardium), computed tomography scan (thickened pericardium and/or pleural effusion), 7 and confirmed by cardiac catheterization (elevated end-diastolic pressure and classic "square root sign" of right ventricular pressure tracing). 8,9 The etiological factors evaluated included underlying diseases, microbiological culture results, and histopathological findings.…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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onstrictive pericarditis, an uncommon disease, is a chronic fibrous thickening of the pericardium that prevents the normal diastolic filling of the heart. Surgery is the only satisfactory treatment. Many factors associated with the development of constrictive pericarditis have been identified, such as infection, post heart surgery, post mediastinal irradiation, but in Western countries the spectrum of etiology has shifted from infection, especially Mycobacterium tuberculosis (Tb), to post heart surgery, although idiopathic causes still predominate. [1][2][3][4] In endemic areas, however, Tb remains the most common cause of constrictive pericarditis. 5,6 Thirteen years experience of constrictive pericarditis patients who underwent total pericardiectomy in a university hospital located in a rural area of Taiwan were reviewed and the clinical characteristics, especially the etiological spectrum, and operative approach were analyzed. MethodsWe retrospectively analyzed the characteristics of 23 patients (19 males, 4 females, age range 25-65 years) who underwent total pericardiectomy for constrictive pericarditis between January 1990 and December 2003. Constrictive pericarditis was diagnosed by chest roentgenography (calcified pericardium), computed tomography scan (thickened pericardium and/or pleural effusion), 7 and confirmed by cardiac catheterization (elevated end-diastolic pressure and classic "square root sign" of right ventricular pressure tracing). 8,9 The etiological factors evaluated included underlying diseases, microbiological culture results, and histopathological findings. Tubercular pericarditis was diagnosed if the histopathological section of pericardium showed the granulomatous changes of Tb. Table 1 shows the clinical characteristics of the study group prior to operation. The most common symptoms were exertional dyspnea (96%), jugular vein distension (96%), hepatomegaly (70%), general fatigue (65%), peripheral edema (65%), and ascites (52%). Pathogens isolated in 11 patients (48%) were Tb in 8 patients (35%) and streptococcus in 2 patients (9%); 1 patient had strongyloidiasis Results Clinical Characteristics and Treatment of Constrictive Pericarditis in TaiwanRobert Fu-Chean Chen, MD; Cha-Po Lai, MD* Background Constrictive pericarditis is an uncommon disease that prevents the normal diastolic filling of the heart and pericardiectomy is the only satisfactory treatment. Methods and ResultsThe clinical characteristics and treatment of patients who underwent pericardiectomy for constrictive pericarditis (n=23) were reviewed. Surgery was performed via left anterolateral thoracotomy plus transsternal extension in 3 patients, and median sternotomy in 20 patients. There were 2 deaths, resulting in an overall mortality rate of 8.7%. Of the 23 patients, 8 had Mycobacterium tuberculosis (Tb) infection, 2 had streptococcus infection, 1 had strongyloidiasis (Strongyloides stercoralis) and 1 developed the condition after a myocardial infarction; 2 patients underwent pericardial substitute insertion as post-hea...

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Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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“…1 Pericardial thickness may help distinguish between these processes. 2 Normal pericardial thickness is 2 mm or less, a thickness greater than 4 mm suggests pericardial constriction, and one greater than 6 mm has a high specificity for constriction. 3 The erroneous conclusion has been drawn that the presence of increased pericardial thickness is an essential diagnostic feature of constrictive pericarditis.…”

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confidence: 99%

Constrictive Pericarditis in 26 Patients With Histologically Normal Pericardial Thickness

Talreja¹,

Edwards²,

Danielson³

et al. 2003

Circulation

396

115

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Background— Traditionally, increased pericardial thickness has been considered an essential diagnostic feature of constrictive pericarditis. Although constriction with a normal-thickness pericardium has been demonstrated clinically by noninvasive imaging, the details of clinicopathological correlates have not been described. Methods and Results— A total of 143 patients with proven constriction underwent pericardiectomy at Mayo Clinic between 1993 and 1999. Their baseline characteristics, operative data, and pathological specimens were reviewed retrospectively. The pericardium was of normal thickness (≤2 mm) in 26 patients (18%; group 1) and was thickened (>2 mm) in 117 (82%; group 2). The most common causes of constriction in group 1 included previous cardiac surgery, chest irradiation, previous infarction, and idiopathic disease. There was little difference in symptoms and findings on physical examination between the 2 groups. Microscopically, no patient had an entirely normal pericardium. Histopathological abnormalities in group 1 were mild and focal, including fibrosis, inflammation, calcification, fibrin deposition, and focal noncaseating granulomas. Pericardiectomy was equally effective in relieving symptoms regardless of the presence or absence of increased thickness. Conclusions— Pericardial thickness was not increased in 18% of patients with surgically proven constrictive pericarditis, although the histopathological appearance was focally abnormal in all cases. When clinical, echocardiographic, or invasive hemodynamic features indicate constriction in patients with heart failure, pericardiectomy should not be denied on the basis of normal thickness as demonstrated by noninvasive imaging.

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“…Lipomas usually have low density, which ranges from -80 to 115 Hounsfield units 20 . The cells in lipomas may be characterized by the criterion proposed by Mendez et al 21 , which considers the mean density of the adipose tissue, ie, density equal to or below -55 Hounsfield units.…”

Section: Discussionmentioning

confidence: 99%