---
title: "Pericardial Calcification"
docid: "102d1a2a-5968-4ccc-bb39-13ea2e395a88"
authors:
- key: "df804626-c042-4296-96e3-836a6da50fd6"
value: "Gregory Kicska, MD, PhD"
breadcrumbs:
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name: "Cardiac"
slug: "cardiac"
treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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name: "Differential Diagnosis"
slug: "differential-diagnosis"
treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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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
. Cardiac chambers appear normal in size. Compare with postsurgical appearance in next image.](images/app.statdx.com_image_thumbnail_713be21c-8889-45cf-a7f6-42a3fd248bdd_annotated_true_size_900_quality_90_23e6b9935f09d52edc8528b3a1bc099c080a0c5a.jpg)
**Prior Pericarditis**
*Axial CECT shows dense pericardial calcifications of the pericardium . Cardiac chambers appear normal in size. Compare with postsurgical appearance in next image.*
**Prior Pericarditis**
*Axial CECT shows dense pericardial calcifications of the pericardium . 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 in a patient with chronic pericarditis due to rheumatoid arthritis. Chronic pericarditis can lead to calcifications.*
.](images/app.statdx.com_image_thumbnail_feefae62-9ce4-4cf4-9d2b-5021fb51ca06_annotated_true_size_900_quality_90_cc3f35837b8d12916537bc3ffb221c61c3d65d9a.jpg)
**Prior Pericarditis**
*Axial CECT in the same patient 10 years later shows development of pericardial calcifications in region of longstanding pericardial thickening. Note focal constriction on right ventricle .*
and dilated atria .](images/app.statdx.com_image_thumbnail_e21e42e2-38aa-4828-ae1b-828cb5a198bb_annotated_true_size_900_quality_90_2ddefb7c24d0fb1d6d1df7fc8917416a2d057a35.jpg)
**Prior Pericarditis**
*Axial CECT shows apical predominant pericardial calcifications in a 45-year-old patient with history of tuberculosis. Note tubular ventricles and dilated atria .*
**Prior Pericarditis**
*Lateral radiograph shows pericardial calcifications of the anterior and inferior wall in a patient with suspected remote pericarditis.*
**Prior Hemopericardium**
*Axial NECT shows high-density pericardial fluid 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 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 in a patient who recently received radiation. Note inflammatory stranding of the chest wall adjacent to the pericardium . These patients may progress to develop pericardial calcifications.*