.
This commit is contained in:
Ross
@@ -0,0 +1,121 @@
|
||||
---
|
||||
title: "Pericardial Calcification"
|
||||
docid: "102d1a2a-5968-4ccc-bb39-13ea2e395a88"
|
||||
authors:
|
||||
- key: "df804626-c042-4296-96e3-836a6da50fd6"
|
||||
value: "Gregory Kicska, MD, PhD"
|
||||
breadcrumbs:
|
||||
-
|
||||
name: "Cardiac"
|
||||
slug: "cardiac"
|
||||
treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
|
||||
-
|
||||
name: "Differential Diagnosis"
|
||||
slug: "differential-diagnosis"
|
||||
treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
|
||||
-
|
||||
name: "Pericardial Calcification"
|
||||
slug: "pericardial-calcification"
|
||||
treeNodeId: null
|
||||
category: "Cardiac"
|
||||
documentVersionId: "93cf53a5-85ce-4d16-b488-1398159edb6e"
|
||||
imageCount: 9
|
||||
lastUpdated: "03/17/22"
|
||||
pageDescription: "Pericardial Calcification"
|
||||
pageKeywords: "Cardiac, Differential Diagnosis, Pericardial Calcification"
|
||||
pageTitle: "Pericardial Calcification | STATdx"
|
||||
enhancedTitle: "Pericardial Calcification"
|
||||
type: "DDX"
|
||||
breadcrumbs:
|
||||
- "Cardiac"
|
||||
- "Differential Diagnosis"
|
||||
- "Pericardial Calcification"
|
||||
---
|
||||
# ESSENTIAL INFORMATION
|
||||
|
||||
- ## Key Differential Diagnosis Issues
|
||||
|
||||
|
||||
- Any cause of chronic or prior pericarditis may cause pericardial calcification
|
||||
- Calcification features or distribution limited in identifying etiology; history most helpful
|
||||
- Calcifications adjacent to pericardium are often mistaken for pericardial calcifications, particularly when overlying left ventricle
|
||||
- Constrictive pericarditis: Pericardial calcification with dilated IVC, SVC, atria, tubular ventricles, and hepatic vein contrast reflux
|
||||
- Reporting spatial location of calcifications assist in planning surgical therapy
|
||||
- ## Helpful Clues for Common Diagnoses
|
||||
|
||||
|
||||
- **Prior Pericarditis**
|
||||
- Although TB is uncommon in developed world, it is common cause of calcified pericardium in developing world
|
||||
- Characteristically thick, irregular, amorphous calcifications predominantly over anterior and inferior RV: Panzer heart appearance on radiography
|
||||
- Uremic pericarditis: Eggshell calcification pattern
|
||||
- Idiopathic: Diagnosis of exclusion; often result of undiagnosed viral infection
|
||||
- ## Helpful Clues for Less Common Diagnoses
|
||||
|
||||
|
||||
- **Prior Hemopericardium**
|
||||
- Most commonly from trauma, malignancy, or surgery
|
||||
- Metastasis
|
||||
- Far more common than primary tumors
|
||||
- Nodular pericardium with coexistent hemopericardium
|
||||
- Lung cancer, breast cancer, and lymphoma account for 75% of cases
|
||||
- ## Helpful Clues for Rare Diagnoses
|
||||
|
||||
|
||||
- **Prior Radiation Therapy**
|
||||
- Acute and chronic forms of radiation pericarditis can lead to calcification
|
||||
- Radiotherapy exceeding 40 Gy, dose commonly delivered for Hodgkin disease or lung cancer
|
||||
- Acute pericarditis can occur weeks to months after radiation
|
||||
- Acute pericarditis is generally symptomatic
|
||||
- Chronic pericarditis does not occur before 6 months
|
||||
- More often leads to constrictive physiology but can be asymptomatic
|
||||
- Fibrosis of adjacent mediastinal adipose tissue
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
**Prior Pericarditis**
|
||||
*Axial CECT shows dense pericardial calcifications of the pericardium <img src='img/arrows/WS.png'/>. Cardiac chambers appear normal in size. Compare with postsurgical appearance in next image.*
|
||||
|
||||
|
||||
**Prior Pericarditis**
|
||||
*Axial CECT shows dense pericardial calcifications of the pericardium <img src='img/arrows/WS.png'/>. Cardiac chambers appear normal in size. Compare with postsurgical appearance in next image.*
|
||||
|
||||
|
||||
**Prior Pericarditis**
|
||||
*Axial CECT in the same patient after pericardial stripping is shown. Cardiac enlargement illustrates the degree of anatomic distortion caused by pericardial constriction.*
|
||||
|
||||
|
||||
**Prior Pericarditis**
|
||||
*Axial NECT shows pericardial thickening <img src='img/arrows/WS.png'/> in a patient with chronic pericarditis due to rheumatoid arthritis. Chronic pericarditis can lead to calcifications.*
|
||||
|
||||
|
||||
**Prior Pericarditis**
|
||||
*Axial CECT in the same patient 10 years later shows development of pericardial calcifications <img src='img/arrows/WS.png'/> in region of longstanding pericardial thickening. Note focal constriction on right ventricle <img src='img/arrows/WC.png'/>.*
|
||||
|
||||
|
||||
**Prior Pericarditis**
|
||||
*Axial CECT shows apical predominant pericardial calcifications in a 45-year-old patient with history of tuberculosis. Note tubular ventricles <img src='img/arrows/WO.png'/> and dilated atria <img src='img/arrows/WC.png'/>.*
|
||||
|
||||
|
||||
**Prior Pericarditis**
|
||||
*Lateral radiograph shows pericardial calcifications of the anterior and inferior wall <img src='img/arrows/WS.png'/> in a patient with suspected remote pericarditis.*
|
||||
|
||||
|
||||
**Prior Hemopericardium**
|
||||
*Axial NECT shows high-density pericardial fluid <img src='img/arrows/WS.png'/> in a patient with hemopericardium. Although this represents the acute presentation, these patients may develop pericardial calcifications.*
|
||||
|
||||
|
||||
**Prior Radiation Therapy**
|
||||
*Short-axis black-blood MR shows signal loss at the anterior pericardium <img src='img/arrows/WS.png'/> in a patient with focal pericardial calcification from prior mediastinal radiation. Signal loss is greater with gradient echo sequences as opposed to the spin echo sequence shown here.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
**Prior Radiation Therapy**
|
||||
*Axial CT shows pericardial fluid and thickening <img src='img/arrows/WO.png'/> in a patient who recently received radiation. Note inflammatory stranding of the chest wall adjacent to the pericardium <img src='img/arrows/WS.png'/>. These patients may progress to develop pericardial calcifications.*
|
||||
|
||||
Reference in New Issue
Block a user