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Cardiac
Diagnosis
Pericardial
Constrictive Pericarditis
Constrictive Pericarditis
Seth Kligerman, MD; John P. Lichtenberger, III, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Noncompliant pericardium due to pericardial scarring leading to impaired ventricular diastolic filling and reduced cardiac output

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Echocardiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Ardhanari S et al: Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis. Indian Heart J. 69(1):57-67, 2017
                                        2. Geske JB et al: Differentiation of constriction and restriction: complex cardiovascular hemodynamics. J Am Coll Cardiol. 68(21):2329-47, 2016
                                        3. Cremer PC et al: Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging. 8(5), 2015
                                        4. Bogaert J et al: Pericardial disease: value of CT and MR imaging. Radiology. 267(2):340-56, 2013
                                        5. Jeung MY et al: Myocardial tagging with MR imaging: overview of normal and pathologic findings. Radiographics. 32(5):1381-98, 2012
                                        6. Thavendiranathan P et al: Simultaneous right and left heart real-time, free-breathing CMR flow quantification identifies constrictive physiology. JACC Cardiovasc Imaging. 5(1):15-24, 2012
                                        7. Peebles CR et al: Pericardial disease--anatomy and function. Br J Radiol. 84 Spec No 3:S324-37, 2011
                                        8. Rajiah P: Cardiac MRI: Part 2, pericardial diseases. AJR Am J Roentgenol. 197(4):W621-34, 2011
                                        9. 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
                                        10. Verhaert D et al: The role of multimodality imaging in the management of pericardial disease. Circ Cardiovasc Imaging. 3(3):333-43, 2010
                                        11. Yared K et al: Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging. 3(6):650-60, 2010
                                        12. Bogaert J et al: Cardiovascular magnetic resonance in pericardial diseases. J Cardiovasc Magn Reson. 11:14, 2009
                                        13. Napolitano G et al: Imaging features of constrictive pericarditis: beyond pericardial thickening. Can Assoc Radiol J. 60(1):40-6, 2009
                                        14. Francone M et al: Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol. 16(4):944-51, 2006
                                        15. Ha JW et al: Images in cardiology. Delayed hyperenhancement of the pericardium by magnetic resonance imaging as a marker of pericardial inflammation in a patient with tuberculous effusive constrictive pericarditis. Heart. 92(4):494, 2006
                                        16. Sagristà-Sauleda J et al: Effusive-constrictive pericarditis. N Engl J Med. 350(5):469-75, 2004
                                        17. Gilkeson RC et al: MR evaluation of cardiac and pericardial malignancy. Magn Reson Imaging Clin N Am. 11(1):173-86, viii, 2003
                                        18. Glockner JF: Imaging of pericardial disease. Magn Reson Imaging Clin N Am. 11(1):149-62, vii, 2003
                                        19. Wang ZJ et al: CT and MR imaging of pericardial disease. Radiographics. 23 Spec No:S167-80, 2003
                                        20. Breen JF: Imaging of the pericardium. J Thorac Imaging. 16(1):47-54, 2001
                                        21. Rozenshtein A et al: Plain-film diagnosis of pericardial disease. Semin Roentgenol. 34(3):195-204, 1999
                                        22. Watanabe A et al: A case of effusive-constructive pericarditis: an efficacy of GD-DTPA enhanced magnetic resonance imaging to detect a pericardial thickening. Magn Reson Imaging. 16(3):347-50, 1998
                                        23. Masui T et al: Constrictive pericarditis and restrictive cardiomyopathy: evaluation with MR imaging. Radiology. 182(2):369-73, 1992
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Noncompliant pericardium due to pericardial scarring leading to impaired ventricular diastolic filling and reduced cardiac output

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Echocardiographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Ardhanari S et al: Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis. Indian Heart J. 69(1):57-67, 2017
                                                                              2. Geske JB et al: Differentiation of constriction and restriction: complex cardiovascular hemodynamics. J Am Coll Cardiol. 68(21):2329-47, 2016
                                                                              3. Cremer PC et al: Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging. 8(5), 2015
                                                                              4. Bogaert J et al: Pericardial disease: value of CT and MR imaging. Radiology. 267(2):340-56, 2013
                                                                              5. Jeung MY et al: Myocardial tagging with MR imaging: overview of normal and pathologic findings. Radiographics. 32(5):1381-98, 2012
                                                                              6. Thavendiranathan P et al: Simultaneous right and left heart real-time, free-breathing CMR flow quantification identifies constrictive physiology. JACC Cardiovasc Imaging. 5(1):15-24, 2012
                                                                              7. Peebles CR et al: Pericardial disease--anatomy and function. Br J Radiol. 84 Spec No 3:S324-37, 2011
                                                                              8. Rajiah P: Cardiac MRI: Part 2, pericardial diseases. AJR Am J Roentgenol. 197(4):W621-34, 2011
                                                                              9. 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
                                                                              10. Verhaert D et al: The role of multimodality imaging in the management of pericardial disease. Circ Cardiovasc Imaging. 3(3):333-43, 2010
                                                                              11. Yared K et al: Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging. 3(6):650-60, 2010
                                                                              12. Bogaert J et al: Cardiovascular magnetic resonance in pericardial diseases. J Cardiovasc Magn Reson. 11:14, 2009
                                                                              13. Napolitano G et al: Imaging features of constrictive pericarditis: beyond pericardial thickening. Can Assoc Radiol J. 60(1):40-6, 2009
                                                                              14. Francone M et al: Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol. 16(4):944-51, 2006
                                                                              15. Ha JW et al: Images in cardiology. Delayed hyperenhancement of the pericardium by magnetic resonance imaging as a marker of pericardial inflammation in a patient with tuberculous effusive constrictive pericarditis. Heart. 92(4):494, 2006
                                                                              16. Sagristà-Sauleda J et al: Effusive-constrictive pericarditis. N Engl J Med. 350(5):469-75, 2004
                                                                              17. Gilkeson RC et al: MR evaluation of cardiac and pericardial malignancy. Magn Reson Imaging Clin N Am. 11(1):173-86, viii, 2003
                                                                              18. Glockner JF: Imaging of pericardial disease. Magn Reson Imaging Clin N Am. 11(1):149-62, vii, 2003
                                                                              19. Wang ZJ et al: CT and MR imaging of pericardial disease. Radiographics. 23 Spec No:S167-80, 2003
                                                                              20. Breen JF: Imaging of the pericardium. J Thorac Imaging. 16(1):47-54, 2001
                                                                              21. Rozenshtein A et al: Plain-film diagnosis of pericardial disease. Semin Roentgenol. 34(3):195-204, 1999
                                                                              22. Watanabe A et al: A case of effusive-constructive pericarditis: an efficacy of GD-DTPA enhanced magnetic resonance imaging to detect a pericardial thickening. Magn Reson Imaging. 16(3):347-50, 1998
                                                                              23. Masui T et al: Constrictive pericarditis and restrictive cardiomyopathy: evaluation with MR imaging. Radiology. 182(2):369-73, 1992