statdx/docs_md/articles/pericardial-calcification_102d1a2a-5968-4ccc-bb39-13ea2e395a88.md

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Pericardial Calcification	102d1a2a-5968-4ccc-bb39-13ea2e395a88	key value df804626-c042-4296-96e3-836a6da50fd6 Gregory Kicska, MD, PhD	name slug treeNodeId Cardiac cardiac fa90100b-619c-430e-8074-b5b9789bab39 name slug treeNodeId Differential Diagnosis differential-diagnosis 952326a0-b3ea-4a21-aa7a-d796cc9325ed name slug treeNodeId Pericardial Calcification pericardial-calcification null	Cardiac	93cf53a5-85ce-4d16-b488-1398159edb6e	9	03/17/22	Pericardial Calcification	Cardiac, Differential Diagnosis, Pericardial Calcification	Pericardial Calcification | STATdx	Pericardial Calcification	DDX	Cardiac Differential Diagnosis Pericardial Calcification

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title: "Pericardial Calcification" docid: "102d1a2a-5968-4ccc-bb39-13ea2e395a88" authors:

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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 . 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.

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 .

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.