Imaging of pericardium Flashcards
fibrous sac that surrounds the heart which is composed of 2 layers
pericardium
innermost layer pericardium that lines the epicardial surface of the heart
visceral pericardium
visceral pericardium is separated from the outermost portion of the myocardium by a
layer of epicardial fat which can vary in thickness
the parietal pericardium is composed of how many layers
2 layers
secrete a small amount of fluid into the pericardial space to lubricate the cavity and therefore the space normally contains 15 to 35 cc of pericardial fluid
mesothelial cells
attached to the mesothelial layer of the parietal pericardium and is composed of various layers of collagen and elastic fibers
fibrous pericardium
on ct, the pericardium is best visualized where
anterior to the anterior wall of the RV where it is outlined by both epicardial and mediastinal fat
appears as a thin 1-2 mm thick curvilinear band of soft tissue surrounding the heart which extends superior to inferiorly from the great vessels to diaphragmatic surface respectively
pericardium
pericardial thickness of greater than ___mm in diameter is considered abnormal
4 mm
portion of the visceral pericardium that covers the vessels is arranged in the form of 2 short tubes. one encloses the proximal portions of the ascending aorta and pulmonary trunk and is termed
arterial mesocardium
the other portion of the visceral pericardium encloses the SVC, IVC and four pulmonary veins and is termed
venous mesocardium
this normal arrangement of the visceral pericardium can lead to outpouchings (recesses) or tunnels (sinuses) which often contain pericardial fluid, even in the absence of a pericardial effusion
arterial and venous mesocardium
sinus that is found posterior and superior to the LA. it is contiguous with the subcarinal region and forms a posterior pericardial recess. given its extension into the subcarinal region, it can be mistaken for lymphadenopathy
oblique sinus
lies superior to the LA, posterior to the aorta and MPA, but anterior to the oblique sinus. it communicates with several recesses including the right pulmonic, left pulmonic, superior aortic, and inferior aortic recesses
transverse sinus
these are usually small in size and form the lateral etens of the transverse sinus
left and right pulmonary recesses
3 recesses of the pericardial cavity
postcaval recess, left pulmonary vein recess and right pulmonary vein recess
blood supply to pericardium
thoracic aorta and pericardiophrenic arteries
venous drainage of pericardium
venae pericardiales which drain to azygos vein, SVC or brachiocephalic veins
innervation of pericardium
phrenic nerve although vagal innervation from the esophageal plexus supplies some of the posterior pericardium
lymphatic drainage of the pericardium
tracheobronchial nodes and less frequently toward the prepericardial lymphatic vessels and nodes
majority of pericardial cysts occur at
cardiophrenic angles, on the right greater than the left
true or false: pericardial cysts, similar to other mediastinal cysts can contain proteinaeous material or blood products, but should not contain septations and internal enhancement
true
pericardial diverticula often cannot be distinguished from pericardial cysts but can be suspected if there is
direct connection of a cyst-like structure to fluid in the pericardial space
absence of the pericardium or pericardial defects are most commonly
post surgical
pericardial defects can be partial or complete, and are much more common on what side
left
Pericardial defects can be associated with what congenital anomalies
ASD, PDA, bicuspid aortic valve or pulmonary abnormalities
Best clue on radiograph is the interposition of lung between the main pulmonary artery and transverse aorta on frontal radiographs in patients with
Complete absence of pericardium or larger partial defects
Type of pericardial effusion that are common in processes that lead to an increase in right atrial pressure, such as CHF and pulmonary hypertension
Transudative effusions
Suggests the presence of a pericardial effusion and occurs when pericardial fluid is outlined on both sides lower attenuation mediastinal and epicardial fat
Fat pad sign
In phase sensitive inversion technique (PSIR), pericardial fluid will appear
Very dark, while epicardial fat will appear bright
Occurs when the pressure in the pericardial space exceeds of the right ventricle
Pericardial tamponade
Typical findings of tamponade
Moderate to large pericardial collection with compression or flattening of the RA and/or RV free wall
Most common cause of tamponade
Effusion
Large percentage of patients with pericardial inflammation are from what etiology
Viral
Patients with acute pericarditis experience
Sharp chest pain which is usually worse on inspiration and when the patient is supine
Thickness of the pericardium in acute pericarditis
4 mm
Certain etiologies of pericarditis are more likely to lead to chronic fibrous thickening. These conditions include,
Relapsing episode of pericarditis such as renal diseas and certain collagen vascular diseases such as RA, SLE and scleroderma, radiation, infection (tuberculosis), and pericardial injury due to surgery or trauma
Enhancement of fibrous pericarditis can be obtained up to how many minutes
10 minutes
Condition in which reduced compliance of the pericardium leads to elevated ventricular diastolic pressures
Constrictive pericarditis
This condition is secondary to equalization of pressures in all cardiac chambers because the total cardiac volume is determined by scarred and inelastic pericardium
Constrictive pericarditis
Noncompliant space in tamponade and constrictive pericarditis can lead to
Ventricular interdependence, as the increased volume in one ventricle leads to decreased volume in the other ventricle
Low cardiac output in constrictive pericarditis particularly affects what side
Right
In echocardiography, this condition shows equalization of pressures during diastole and the decrease or reversal of blood flow in the hepatic veins during expiration
Constrictive pericarditis
Pericardial calcification may be evident in what type of pericarditis
Constrictive
Poor compliance of the pericardium in constrictive pericarditis can change the shape of cardiac chambers as the ventricules may show a
Conical appearance
Associated findings in constrictive pericarditis as well as tamponade due to elevated right heart pressures
Dilation of SVC, azygos vein, ascites, pleural effusions and peripheral edema
Ventricular interdependence in constrictive pericarditis can lead to a classic ____ due to early increase in RV pressures which leads to paradoxical leftward motion of the septum in early diastolic filling
Septal bounce
One of the best methods to make the diagnosis of constrictive pericarditis on MRI is to demonstrate
Respiratory variation of the diastolic bounce using free-breathing, nongated cine MRI sequences
On expiratory MRI imaging, this feature can help differentiate CP From restrictive cardiomyopathy
Positive intrathoracic pressure increases pulmonary return resulting in a normal configuration of the septum of septal bowing to the right. This is not seen in restrictive cardiomyopathy
in rare instances, a patient may present with both a large pericardial effusion and a stiff, noncompliant pericardium, leading to both tamponade and constrictive physiologies, respectively. this syndrome is referred to as
effusive constrictive pericarditis
appears as encapsulated fatty lesion with focal inflammation centered in the juxtapericardial fat
epicardial fat necrosis, also called pericardial fat necrosis
50% of primary pericardial neoplasms
pericardial mesothelioma
true or false: unlike pleural mesothelioma, the association between asbestos exposure and pericardial mesothelioma is unclear
true
demonstrates heterogeneous pericardial effusions and pericardial thickening that early in the disease it may be mistaken for acute or chronic pericarditis
pericardial mesothelioma
true or false: pericardial mesothelioma has poor prognosis, with few patients survive longer than 12 months after diagnosis
true
common intrapericardial germ cell tumors that occur in children are
benign teratomas
malignant pericardial germ cell tumors in children should be considered with a heterogeneous appearance, especially if it is located between the
aortic root and LA
if fat is present in an intrapericardial tumor, ____ or ____ should be considered
teratomas or lipoblastomas
appears as localized or serpiginous masses primarily of fluid attenuation on CT
lymphangiomas
enhancement pattern in pericardial lymphangiomas
no internal enhancement, except for the septations
enhancement pattern of pericardial hemangiomas
nodular enhancement with progressive filling over time
most common malignancies to involve the pericardium and can occur through direct invasion or metastatic spread
lung cancer, breast cancer, lymphoma, melanoma and renal cell ca
