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Cardiac Imaging > Pericardial Disease > Flashcards

Pericardial Disease Flashcards

1
Q

Pericardial cysts and diverticula - definition?

A

Pericardial Cysts: Fluid filled thin walled cavities without communication to the pericardial fluid
Pericardial Diverticula: focal outpouching of the pericard with communication to the pericardial fluid

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2
Q

Pericardial cysts - epidemiology ?

A 
rare - incidence ~ 1:1Mio
~7% of all mediastinal tumors
~13-33% of all mediastinal cysts
most common location - right costophrenic angle
less frequent - left paracardial border
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3
Q

Pericardial cysts - clinical symptoms ?

A

~50% asymptomatic
rarely dyspnea, dysphagia, retrosternal pain, fever, cardiac insufficiency
Complications: infection, rupture, RVOT obstruction

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4
Q

Pericardial cysts - therapy

A

Complete surgical removal in symptomatic patients

Puncture and drainage only with concomitant alcohol instillation or tissue-adhesive successful

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5
Q

Pericardial cysts - MRI findings ?

A

Alternative to CT for evaluation of size, location, content
characteristically: T1w hypointense, T2w hyperintense
in protein-rich cysts: T1w hyperintense, T2w iso- to hypointense
no contrast enhancement
differentiation of cysts and diverticula with cine images

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6
Q

Pericardial cysts - differential diagnosis (DDx) ?

A
  • peri- or paracardial fat deposits
  • thymidine cysts, bronchogenic cysts
  • echinococcal cyst
  • cystic tumors: teratoma, neurogenic tumors, lymphangioma
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7
Q

Pericardial hypoplasia / aplasia - facts ?

A
  • partial or complete absence of pericardium
  • most often congenital, rarely iatrogenic
  • very rare
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8
Q

Pericardial hypoplasia / aplasia - clinical symptoms, complications, therapy ?

A

complete aplasia usually asymptomatic, sometimes unspecific thoracic pain and / or dyspnea
partial aplasia can rarely lead to severe complications because of herniation (mPA or left atrial appendage) with syncope, myocardial infarction, sudden cardiac death
increased risk of aortic dissection
therapy: surgical pericardial plastic in case of herniations

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9
Q

Pericardial hypoplasia / aplasia - MRI findings ?

A
  • interruption of the pericardium with sufficient epicardial fat
  • atypical cardiac position
  • interposition of lung tissue between inferior cardiac surface and diaphragm or aorta and mPA respectively
  • atypical motility of the cardiac apex and intermittent herniations with cine images
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10
Q

Pericardial hypoplasia / aplasia - differential diagnosis ?

A
  • ASD
  • pulmonary stenosis
  • mitral valve disease
  • pulmonary hypertension / embolus
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11
Q

Pericardial tumors - definition and epidemiology ?

A
  • most frequent malignancies: pericardial metastasis
  • most frequent primary malignancy: mesothelioma
  • most frequent benign tumors: pericardial cyst, lipoma
  • other benign tumors: fibroma, teratoma, haemangioma
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12
Q

Pericardial tumors - clinical symptoms, complications and prognosis ?

A

unspecific
usually as a result of pericardial effusion, pericarditis or infiltration of adjacent structures
arrhythmia, ventricular compromise
mortality ~10-30% also with benign tumors
mortality ~100% within 3 years in malignancies

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13
Q

Pericardial tumors - therapy ?

A

surgical resection in benign tumors

palliative, symptomatic and conservative drug therapy in most malignancies

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14
Q

Pericardial tumors - MRI findings ?

A
  • localisation
  • infiltration of adjacent structures
  • differentiation of various tumor entities with signal and contrast pattern
  • dynamic information with cine imaging
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15
Q

Pericardial tumors - differential diagnosis (DDx) ?

A
  • pericarditis (infectious, inflammatory, idiopathic)
  • post-therapeutic pericarditis (chemotherapy, radiation)
  • postoperative seroma / haematoma
  • pericardial tamponade
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16
Q

Pericardial tamponade - definition and epidemiology ?

A

Life-threatening filling of the pericardial sac with increase of pericardial pressure and concomitant cardiac compromise
incidence of small pericardial effusion ~10-15%
incidence of pericardial effusions requiring drainage ~0.02-0.03%

17
Q

Pericardial tamponade - aetiology ?

A

Manifold aetiologies: infection/inflammation, trauma, postoperativ, aortic dissection, myocardial infarction, Dressler syndrome, pericardial neoplasia
Content: blood, pus, lymph, gas
filling speed is crucial

18
Q

Pericardial tamponade - clinical symptoms ?

A

Clinical diagnosis - Beck’s triad

  • decreased arterial pressure
  • distended neck veins without known cardiac insufficiency
  • faint/muffled heart sounds
19
Q

Pericardial tamponade - therapy ?

A
  • puncture and drainage

- surgical thoracotomy

20
Q

Pericardial tamponade - imaging (TEE) ?

A
  • method of choice
  • early diastolic collapse of the right ventricle
  • late diastolic / early systolic collapse of the right atrium
  • early diastolic left atrial collapse (in pulmonary hypertension - specific but rare)
  • paradoxical movement of the interventricular septum
  • swinging heart
  • reduced E-wave
  • reduced / increased diastolic transmitral forward flow during inspiration / exspiration
21
Q

Pericardial tamponade - imaging (CT and MRI) ?

A
  • usually not indicated
  • differentiation, characterisation of pericardial fluid
  • in case of suspected tumor
  • therapy planning
22
Q

Pericardial tamponade - differential diagnosis (DDx) ?

A
  • constrictive pericarditis
  • tension pneumothorax
  • restrictive cardiomyopathy
  • acute right heart insufficiency in pulmonary embolism
  • myocardial infarction
  • cardiac insufficiency
23
Q

Constrictive pericarditis - definition ?

A
  • possible consequence of acute pericarditis with scarred/calcific transformation and reduced elasticity
  • impairment of diastolic filling with preservation of systolic function
24
Q

Constrictive pericarditis - aetiology ?

A

most common viral or idiopathic
consequence of cardiac surgery or radiation therapy
rarely postinfectious, immunologic, trauma, sarcoidosis, uraemia etc.
pathophysiologic characteristic: diastolic pressure equalisation of all 4 chambers

25
Q

Constrictive pericarditis - epidemiology ?

A

~ 0.5% after acute pericarditis of viral or idiopathic origin
~ 2-5% after pericarditis immunologic and neoplastic origin
~ 20-30% after pericarditis of bacterial origin
incidence of effusive pericarditis ~3.6%

26
Q

Constrictive pericarditis - clinical symptoms ?

A
  • elevated systemic venous pressures
  • decreased cardiac output
  • typical for right heart insufficiency
27
Q

Constrictive pericarditis - therapy and prognosis ?

A
  • pericardectomy (mortality up to ~9%)
  • antibiotic therapy in tuberculous pericarditis
  • non-steroidal antiphlogistic therapy in transient pericarditis
28
Q

Constrictive pericarditis - imaging (TEE) ?

A
  • septal bounce: early diastolic movement of the interventricular septum towards the left ventricle during inspiration and inverse pattern during exspiration
  • dilated SVC / IVC and atria
  • small or absent A-wave in Doppler
29
Q

Constrictive pericarditis - imaging (CT) ?

A
  • focal calcifications
  • pericardial thickening > 4mm
  • enlarged atria
  • tubular form of the right ventricle
30
Q

Constrictive pericarditis - imaging (MRI) ?

A
  • thickened pericard
  • late enhancement
  • differentiation of small pericardial effusion from pericardial thickening
  • paradoxical septal movement during inspiration
31
Q

Constrictive pericarditis - differential diagnosis (DDx)

A
  • restrictive cardiomyopathy
  • COPD
  • pulmonary hypertension
  • shunts
  • ARVC/ARVD
  • right ventricular infarct
32
Q

Dressler-Syndrome - definition and facts ?

A
  • occurs usually 2-3 weeks up to months after MI
  • prevalence ~ 1% and ~ 3-5% after MI
  • apparently associated with pericardial bleeding
  • possible autoimmune
33
Q

Dressler-syndrome - clinical symptoms ?

A
  • fatigue, fever, pleuritic pain worse with inspiration
  • pericardial effusion
  • elevated inflammatory parameters
  • ECG: low voltage, ST-elevation (~60%)
34
Q

Dressler-syndrome - therapy and prognosis ?

A 
- Aspirin / NSAIDs
worse prognosis: 
- high fever
- subacute course
- large pericardial effusion
35
Q

Dressler-syndrome - imaging ?

A

TTE: pericardial effusion
CT: pericardial thickening and localisation / complications
MRI: LGE, monitoring therapy

36
Q

Dressler-syndrome - differential diagnosis (DDx) ?

A
  • post-infarction pericarditis
  • post-traumatic pericarditis
  • post-interventional pericarditis
  • acute pericarditis (idiopathic, viral, bacterial, neoplastic, uraemic)
  • pleuropneumonia
  • CAD
  • pulmonary embolus
  • aortic dissection

Cardiac Imaging (9 decks)

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