Computed Tomography and Magnetic Resonance Imaging of the Pericardium

The imaging appearances of various pericardial disorders

The pericardium could be involved in a variety of clinical disorders. The imaging findings are not specific for an individual pathology in most of the cases; however, patient’s clinical history may guide radiologist to a definitive diagnosis. Congenital absence of the pericardium could be recognized with the imaging appearance of interposed lung tissue between the main pulmonary artery and aorta. Pericardial effusion is a non-specific condition that may occur due to inflammatory, infectious, and neoplastic disorders. Cardiac tamponade may occur in case of massive or rapid accumulation of fluid in the pericardial sac. Pericardial calcification is a common and easily identified entity on a computed tomography (CT) scan. Presence of calcification and/or fibrosis may result in pericardial constriction. Nevertheless, the pulsation of an adjacent coronary artery may prevent calcification formation in a focal area and consequently may result in pericardial diverticulum containing epicardial fat and coronary artery. The imaging findings encountered in patients with pericardial hydatid disease and Erdheim-Chester disease may mimic those of pericardial neoplasia. Pericardial adhesions and pedicled fat flaps may cause confusion on a CT scan in the post-surgical period following cardiac surgery. Pericardial fat necrosis can be diagnosed by CT in patients with chest pain. The radiologists should be familiar with the medical devices placed in pericardial space for certain individual indications. A pericardial patch and temporary epicardial pacemaker wires could be identified on a CT scan.

Emergencies in Hematology and Oncology

The development of medical emergencies related to the underlying disease or as a result of complications of therapy are common in patients with hematologic or solid tumors. These oncological emergencies can occur as an initial presentation or in a patient with an established diagnosis and are encountered in all medical care settings, ranging from primary care to the emergency department and various subspecialty environments. Therefore, it is critically important that all physicians have a working knowledge of the potential oncological emergencies that may present in their practice and how to provide the most effective care without delay. This article reviews the most common oncological emergencies and provides practical guidance for initial management of these patients.

[The role of multimodality imaging in the diagnosis of constrictive pericarditis]

Constrictive pericarditis is a rare heart disease. The diagnosis remains a challenge. In fact, this illness can mimic restrictive cardiomyopathy. Echo-Doppler evaluation helps to establish the diagnosis of constriction; however, this technique is limited in its ability to image the entire pericardium because of its limited acoustic windows by air or bone of thorax. In addition, it is an operator-dependent exploration. Scanner and magnetic resonance imaging provide a large field of view and excellent images, showing the increased pericardial thickness and septal motion abnormalities. This review will consider the emerging role of these imaging modalities in the constrictive pericarditis diagnosis.

(18)F-FDG PET/CT in differentiating acute tuberculous from idiopathic pericarditis: preliminary study

PURPOSE

The aim of this study was to evaluate retrospectively the diagnostic capability of F-FDG PET/CT in differentiating acute tuberculous from idiopathic pericarditis.

METHODS

FDG PET/CT findings were reviewed in 15 patients with acute tuberculous (n = 5) or idiopathic pericarditis (n = 10). The maximal thickness and SUVmax of the pericardium and the number, size, and SUVmax of the mediastinal and supraclavicular lymph nodes with increased FDG uptake were measured.

RESULTS

All patients had small-to-large amount of pericardial effusion. The patients with acute tuberculous pericarditis (n = 5) showed diffuse (n = 3) or multifocal (n = 2) FDG uptake in the pericardia. The patients with acute idiopathic pericarditis (n = 10) showed diffuse (n = 6) or regional (n = 4) FDG uptake in the pericardia. The mean (SD) pericardial thickness and SUVmax of acute tuberculous pericarditis were significantly higher than those of acute idiopathic pericarditis (5.1 [1.0] vs 3.4 [0.9], P < 0.05; 13.5 [3.9] vs 3.0 [0.7], P < 0.05, respectively). A total of 69 mediastinal and supraclavicular lymph nodes with increased FDG uptake were observed in all 15 patients (44 in patients with acute tuberculous pericarditis and 25 in patients with acute idiopathic pericarditis). The mean (SD) SUVmax of mediastinal and supraclavicular lymph nodes of acute tuberculous pericarditis (5.3 [1.8]) was significantly higher than that of acute idiopathic pericarditis (2.8 [0.6], P < 0.05). There was no significant difference in the mean size of the mediastinal and supraclavicular lymph nodes between acute tuberculous and idiopathic pericarditis.

CONCLUSIONS

The degrees of FDG uptake in the pericardium and the mediastinal and supraclavicular lymph nodes are useful for differentiating acute tuberculous from idiopathic pericarditis. Familiarity with the FDG uptake patterns of acute tuberculous and idiopathic pericarditis may be helpful for successful (especially timely) diagnosis and treatment.