122 lines
9.0 KiB
Markdown
122 lines
9.0 KiB
Markdown
---
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title: "Pericardial Calcification"
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docid: "102d1a2a-5968-4ccc-bb39-13ea2e395a88"
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authors:
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- key: "df804626-c042-4296-96e3-836a6da50fd6"
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value: "Gregory Kicska, MD, PhD"
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breadcrumbs:
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-
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name: "Cardiac"
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slug: "cardiac"
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treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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-
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name: "Pericardial Calcification"
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slug: "pericardial-calcification"
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treeNodeId: null
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category: "Cardiac"
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documentVersionId: "93cf53a5-85ce-4d16-b488-1398159edb6e"
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imageCount: 9
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lastUpdated: "03/17/22"
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pageDescription: "Pericardial Calcification"
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pageKeywords: "Cardiac, Differential Diagnosis, Pericardial Calcification"
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pageTitle: "Pericardial Calcification | STATdx"
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enhancedTitle: "Pericardial Calcification"
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type: "DDX"
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breadcrumbs:
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- "Cardiac"
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- "Differential Diagnosis"
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- "Pericardial Calcification"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Any cause of chronic or prior pericarditis may cause pericardial calcification
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- Calcification features or distribution limited in identifying etiology; history most helpful
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- Calcifications adjacent to pericardium are often mistaken for pericardial calcifications, particularly when overlying left ventricle
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- Constrictive pericarditis: Pericardial calcification with dilated IVC, SVC, atria, tubular ventricles, and hepatic vein contrast reflux
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- Reporting spatial location of calcifications assist in planning surgical therapy
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- ## Helpful Clues for Common Diagnoses
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- **Prior Pericarditis**
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- Although TB is uncommon in developed world, it is common cause of calcified pericardium in developing world
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- Characteristically thick, irregular, amorphous calcifications predominantly over anterior and inferior RV: Panzer heart appearance on radiography
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- Uremic pericarditis: Eggshell calcification pattern
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- Idiopathic: Diagnosis of exclusion; often result of undiagnosed viral infection
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- ## Helpful Clues for Less Common Diagnoses
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- **Prior Hemopericardium**
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- Most commonly from trauma, malignancy, or surgery
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- Metastasis
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- Far more common than primary tumors
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- Nodular pericardium with coexistent hemopericardium
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- Lung cancer, breast cancer, and lymphoma account for 75% of cases
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- ## Helpful Clues for Rare Diagnoses
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- **Prior Radiation Therapy**
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- Acute and chronic forms of radiation pericarditis can lead to calcification
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- Radiotherapy exceeding 40 Gy, dose commonly delivered for Hodgkin disease or lung cancer
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- Acute pericarditis can occur weeks to months after radiation
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- Acute pericarditis is generally symptomatic
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- Chronic pericarditis does not occur before 6 months
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- More often leads to constrictive physiology but can be asymptomatic
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- Fibrosis of adjacent mediastinal adipose tissue
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## Images
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### Selected Images
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**Prior Pericarditis**
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*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.*
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**Prior Pericarditis**
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*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.*
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**Prior Pericarditis**
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*Axial CECT in the same patient after pericardial stripping is shown. Cardiac enlargement illustrates the degree of anatomic distortion caused by pericardial constriction.*
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**Prior Pericarditis**
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*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.*
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**Prior Pericarditis**
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*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'/>.*
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**Prior Pericarditis**
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*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'/>.*
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**Prior Pericarditis**
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*Lateral radiograph shows pericardial calcifications of the anterior and inferior wall <img src='img/arrows/WS.png'/> in a patient with suspected remote pericarditis.*
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**Prior Hemopericardium**
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*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.*
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**Prior Radiation Therapy**
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*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.*
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### Additional Images
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**Prior Radiation Therapy**
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*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.*
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