1. BY DR. TARIQ MASOOD

2. Pericardial effusion
Constrictive pericarditis.
Pericardial cyst
Hematomas
Neoplasm
Congenital absence of pericardium

5. Pericardial effusion
Causes;
Myocardial infarction,most common
Collagen vascular disease,especially Lupus
Trauma,Surgical or accidental
Metastatic disease
Tuberculosis, uncommon except in AIDS
Viral infection,Coxsackie A and B virus
Uremia,18% in acute uremia

6. Plain x ray
Suggestive but not usually diagnostic
"Water bottle configuration" (major DDX is
cardiomegaly)
Loss of retrosternal clear space
"Fat-pad sign“(produced by separation of retrosternal
from epicardial fat line >2 mm)
 Uncommon but specific
Rapidly enlarging cardiac silhouette with normal
pulmonary vascularity

7. Pericardial effusion on both
frontal chest radiograph and
axial CT. Red arrow points to
fat outside of
pericardium. Green
arrow points to pericardial
space which is 8 mm in this
patient (<4 mm is normal.)
The yellow arrow points to
fat outside of heart and
the blue arrow to the
myocardium.

8. .

10. CT
May detect small effusions (50cc)
Fluid-filled space surrounding the myocardium
Early effusions accumulate posteriorly first.

14. Echocardiogram
Study of choice
Echo-free fluid between the visceral and parietal
pericardium
Early effusions accumulate posteriorly first
> 1cm is usually defined as a “large” effusion

16. Pericarditis
Acute
Chronic
Recurrent
Constrictive

17. Acute pericarditis;
Acute pericarditis is dry, fibrinous or effusive,
independent from its etiology.

18. Chronic pericarditis
Chronic ( 3 months) pericarditis includes effusive
(inflammatory or hydropericardium in heart failure),
adhesive, and constrictive forms.
curable causes are tuberculosis, toxoplasmosis,
myxedema, autoimmune, and systemic diseases.

19. Constrictive pericarditis
Constrictive pericarditis is a rare but severely disabling
consequence of the chronic inflammation of the pericardium,
leading to an impaired filling of the ventricles and reduced
ventricular function.
Increased pericardial thickness is considered an essential
diagnostic feature of constrictive pericarditis.
Tuberculosis, mediastinal irradiation, and previous cardiac
surgical procedures are frequent causes of the disease

22. NCCT thorax showing the
thickened pericardium

23. Chest CT of a patient with clinical
constrictive pericarditis and with
no calcification on chest
radiograph. Areas of pericardial
calcification are evident
(horizontal arrows), but in other
areas (anterior face, vertical arrow)
the pericardium had a normal
appearance.

27. Axial and coronal black-blood
images of a patient with
constrictive pericarditis after
CABG. Arrows point to the
thickened pericardium.

28. Pericardial Cyst
Congenital pericardial cysts are uncommon;
 they may be unilocular or multilocular, with the
diameter from 1–5 cm.
 Inflammatory cysts comprise pseudocysts as well as
encapsulated and loculated pericardial effusions,
caused by rheumatic pericarditis, bacterial infection,
particularly tuberculosis, trauma and cardiac surgery.

29.  Echinococcal cysts usually originate from ruptured
hydatid cysts in the liver and lungs. cysts are detected
incidentally on chest x ray as an oval, homogeneous
radiodense lesion, usually at the right cardiophrenic
angle.
 Echocardiography is useful, but additional imaging by
computed tomography (density readings) or magnetic
resonance is often needed.

32. Axial CT of the chest reveals a
well-defined cystic structure
measuring approximately 3.5 cm in
diameter located in the right
cardiophrenic angle, abutting the
right heart border. This is most
likely a pericardial cyst

33. Modified 4-chamber view
showing the pericardial cyst
(★) without compression of
the left ventricle

34. 

37. Pericardial Neoplasm

38. Differential Diagnosis of Pericardial Masses

39. A high-density mass was
noted (arrows) adjacent to the
right cardiac border,
compromising and displacing
the heart toward the left. A
biopsy was performed, and it
was shown to be a pericardial
mesothelioma

40. Pericardial
Teratoma
Mixeddensity mass with
caicification on the right side
of middle mediastinum

41. Pericardial Metastasis
Metastatic pericardial disease commonly presents as
hemorrhagic effusion. Tumor nodules may enhance after
intravenous contrast administration.
Most frequent CT features of pericardial metastases
include, in order of decreasing frequency:
pericardial effusion
prepericardial lymph nodes
pericardial thickening and enhancement
nodules

42. Squamous cell carcinoma
with pericardial
metastasis.
Computed tomography of the
chest performed after the
administration of contrast
material revealed multiple
pericardial masses with
central necrosis compatible
with metastatic disease.

43. Congenital absence of pericardium
Congenital defects of the pericardium comprise
partial left (70%), right (17%) or total bilateral (rare)
pericardial absence. Additional congenital
abnormalities occur in 30% of patients.
 Most patients with a total pericardial absence are
asymptomatic.

44. Homolateral cardiac displacement and augmented
heart mobility impose an increased risk for traumatic
aortic dissection.
 Partial left side defects can be complicated by
herniation and strangulation of the heart through the
defect (chest pain, shortness of breath, syncope or
sudden death).

45. Axial T1 MRI of the heart
revealing the partial defect of
the left pericardium.

46. On magnetic resonance imaging, T2weighted gradient-echo (*) axial ,
and coronal views showed left
pterolateral rotation and
displacement of the heart, with the
apex located in a posterior position.

47. Thanks