R3 Baylosis, Barry

Barry Baylosis

Hi Barry

The points I want to try and get across
How to diagnose constrictive pericarditis on CT
- Questions and Answers
  - - What are the signs of constrictive pericarditis on CT
      - pericardial thickening
        
        diffuse or localized(2mm – 3mm equivocal)
      - signs of impaired diastolic filling of the right ventricle
      - ie signs of right heart failure including
        
        dilatation of the
        
        RA
        
        IVC and hepatic veins
        
        Coronary Sinus
        
        Azygos vein
        
        Hepatomegaly
      - What is the role of the CXR and LA in Dx
        
        increase in left atrial because it cannot fill therefore
        
        increase in pulmonary venous pressure
        
        Usually normal size LA
        
        However since LA hmay be only partly covered by pericardium, it may in fact enlar

In our patient there is
- no pericardial thickening
- minor pericardial calcification

CORONARY CALCIFICATION AND PERICARDIAL CALCIFICATION

CORONARY CALCIFICATION AND PERICARDIAL CALCIFICATION

There are
- - focal adhesions near the LAD

PERICARDIAL ADHESION

Are There Signs of Constriction?

Consider

Pericardium Thickness
Size of the Right Atrium

? CONSTRICTION – NORMAL SIZED ATRIAL CHAMBERS
The axial image through the region of the AV valves shows normal sized atria. Constriction would be unlikely in the face of a normal sized right atrium. Note the flattened surface of the right atrium
Ashley Davidoff MD

? Size of the Coronary Sinus

? CONSTRICTION – NORMAL SIZED CORONARY SINUS
The axial image through the region of the normal sized coronary sinus. Constriction would be unlikely in the face of a normal sized coronary sinus. Note the flattened surface of the right atrium.
Ashley Davidoff MD

? Size of the Azygos Vein and IVC

QUESTION CONSTRICTION
The axial image is through the region of the normal azygos vein (above) and the normal sized IVC (below). Constrictive pericarditis would be unlikely in the face of a normal sized azygos vein and IVC.

Thus constrictive pericarditis is not present

Links and References

Napolitano G et al Imaging Features of Constrictive Pericarditis: Beyond Pericardial Thickening Canadian Association of Radiologists Journal Volume 60, Issue 1, February 2009, (good review)

Senapati A et al, Disparity in spatial distribution of pericardial calcifications in constrictive pericarditis Openheart BMJmj. Volume 5, Issue 2

Khalid, N et al Pericardial Calcification StatPearls

Next Ahmed El-Araby, Fat and the Heart