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Chronic Inflammatory Pericarditis
Seth Kligerman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Synonyms

          • Chronic pericarditis
          • Chronic sclerosing pericarditis
          • Chronic fibrosing pericarditis
        • Definitions

          • No strict definition of chronic pericarditis, although some criteria have been suggested
            • Acute pericarditis: Acute inflammation of pericardium that resolves in majority of patients
            • Incessant pericarditis: Inflammation of pericardium that persists for 4-6 weeks
            • Chronic pericarditis: Inflammation of pericardium lasting > 3 months; often associated with pericardial fibrosis
            • Recurrent pericarditis: Relapse of pericarditis with ~ 4-6 weeks between previous and current episode
          • Chronic pericarditis is not synonymous with constrictive pericarditis
            • While many patients have pericardial fibrosis, not all patients with pericardial fibrosis have physiologic constriction
            • However, nearly all patients with pericardial constriction do have pericardial fibrosis

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Staging, Grading, & Classification

                      • Gross Pathologic & Surgical Features

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            • Treatment

                              Selected References

                              1. Kligerman S: Imaging of pericardial disease. Radiol Clin North Am. 57(1):179-99, 2019
                              2. Cremer PC et al: Complicated pericarditis: understanding risk factors and pathophysiology to inform imaging and treatment. J Am Coll Cardiol. 68(21):2311-28, 2016
                              3. Aquaro GD et al: Role of tissue characterization by cardiac magnetic resonance in the diagnosis of constrictive pericarditis. Int J Cardiovasc Imaging. 31(5):1021-31, 2015
                              4. Alter P et al: MR, CT, and PET imaging in pericardial disease. Heart Fail Rev. 18(3):289-306, 2013
                              5. Bogaert J et al: Pericardial disease: value of CT and MR imaging. Radiology. 267(2):340-56, 2013
                              6. Young PM et al: MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging. 28(5):1099-109, 2012
                              7. Zurick AO et al: Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. JACC Cardiovasc Imaging. 4(11):1180-91, 2011
                              8. Soler-Soler J et al: Relapsing pericarditis. Heart. 90(11):1364-8, 2004
                              9. Wang ZJ et al: CT and MR imaging of pericardial disease. Radiographics. 23 Spec No:S167-80, 2003
                              10. Fowler NO et al: Recurrent acute pericarditis: follow-up study of 31 patients. J Am Coll Cardiol. 7(2):300-5, 1986
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    TERMINOLOGY

                                    • Synonyms

                                      • Chronic pericarditis
                                      • Chronic sclerosing pericarditis
                                      • Chronic fibrosing pericarditis
                                    • Definitions

                                      • No strict definition of chronic pericarditis, although some criteria have been suggested
                                        • Acute pericarditis: Acute inflammation of pericardium that resolves in majority of patients
                                        • Incessant pericarditis: Inflammation of pericardium that persists for 4-6 weeks
                                        • Chronic pericarditis: Inflammation of pericardium lasting > 3 months; often associated with pericardial fibrosis
                                        • Recurrent pericarditis: Relapse of pericarditis with ~ 4-6 weeks between previous and current episode
                                      • Chronic pericarditis is not synonymous with constrictive pericarditis
                                        • While many patients have pericardial fibrosis, not all patients with pericardial fibrosis have physiologic constriction
                                        • However, nearly all patients with pericardial constriction do have pericardial fibrosis

                                    IMAGING

                                    • General Features

                                      • Radiographic Findings

                                        • CT Findings

                                          • MR Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • Staging, Grading, & Classification

                                                  • Gross Pathologic & Surgical Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          Selected References

                                                          1. Kligerman S: Imaging of pericardial disease. Radiol Clin North Am. 57(1):179-99, 2019
                                                          2. Cremer PC et al: Complicated pericarditis: understanding risk factors and pathophysiology to inform imaging and treatment. J Am Coll Cardiol. 68(21):2311-28, 2016
                                                          3. Aquaro GD et al: Role of tissue characterization by cardiac magnetic resonance in the diagnosis of constrictive pericarditis. Int J Cardiovasc Imaging. 31(5):1021-31, 2015
                                                          4. Alter P et al: MR, CT, and PET imaging in pericardial disease. Heart Fail Rev. 18(3):289-306, 2013
                                                          5. Bogaert J et al: Pericardial disease: value of CT and MR imaging. Radiology. 267(2):340-56, 2013
                                                          6. Young PM et al: MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging. 28(5):1099-109, 2012
                                                          7. Zurick AO et al: Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. JACC Cardiovasc Imaging. 4(11):1180-91, 2011
                                                          8. Soler-Soler J et al: Relapsing pericarditis. Heart. 90(11):1364-8, 2004
                                                          9. Wang ZJ et al: CT and MR imaging of pericardial disease. Radiographics. 23 Spec No:S167-80, 2003
                                                          10. Fowler NO et al: Recurrent acute pericarditis: follow-up study of 31 patients. J Am Coll Cardiol. 7(2):300-5, 1986