Role of computed tomography (CT) in diagnosis of pericardial diseases

Peter Joseph Abd El Nour Goubrial;

Abstract


Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. Inflammatory diseases of the pericardium constitute a spectrum ranging from acute pericarditis to chronic constrictive pericarditis. Other important entities that involve the pericardium include benign and malignant pericardial masses, pericardial cysts, and diverticula, as well as congenital absence of the pericardium (Yared et al., 2010)
Echocardiography is the method of choice for evaluating most pericardial diseases. When competently performed in patients with good acoustic windows, echocardiography accurately detects all pericardial effusions and provides clinically relevant information about their size and hemodynamic importance. The technique is less reliable than magnetic resonance imaging (MRI) and computed tomography (CT) in detecting pericardial thickening/constriction and calcification as well as small loculated effusions, but is still extremely useful in these conditions. (Foster et al., 2011)
In the evaluation of pericardial diseases, computed tomography (CT) and magnetic resonance (MR) imaging traditionally have been used as adjuncts to echocardiography. However, CT is particularly useful as sensitive and noninvasive methods for evaluating loculated or hemorrhagic pericardial effusion, constrictive pericarditis, and pericardial masses. CT provides excellent delineation of the pericardial anatomy and can aid in the precise localization and characterization of various pericardial lesions, including effusion, constrictive pericarditis and pericardial thickening, pericardial masses, and congenital anomalies such as partial or complete absence of the pericardium. It provides a larger field of view than does echocardiography, allowing the examination of the entire chest and detection of associated abnormalities in the mediastinum and lungs. Soft-tissue contrast on CT scans is superior to that on echocardiograms. Given the many potential applications of these modalities in the evaluation of pericardial diseases, familiarity with the CT features of these diseases is important. (Wang et al., 2003)
The pericardium, consisting of a fibroserous sac that encloses the heart, is routinely imaged on CT. Multidetector technology, in allowing rapid acquisition of volumetric data in high resolution and multiplanar reformation, has improved anatomic imaging. Imaging with narrow collimation results in improved delineation of cardiovascular anatomy. The pericardial space normally contains a small amount of fluid (15–20 ml), and the fluid-filled recesses and sinuses can be misinterpreted as adenopathy or abnormality of an adjacent mediastinal structure. In oncologic imaging, staging and prognostic implications of fluid in a pericardial recess misinterpreted as adenopathy can significantly alter management and therapy (Truong et al., 2003).


Other data

Title Role of computed tomography (CT) in diagnosis of pericardial diseases
Other Titles دور التصوير المقطعي في تشخيص أمراض التامور
Authors Peter Joseph Abd El Nour Goubrial
Issue Date 2017

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