HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, Z. J. Articles by Higgins, C. B. Search for Related Content PubMed PubMed Citation Articles by Wang, Z. J. Articles by Higgins, C. B. Related Collections Magnetic Resonance Imaging Cardiac Radiology Computed Tomography

CT and MR Imaging of Pericardial Disease¹

¹ From the Department of Radiology, Box 0628, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628. Presented as an education exhibit at the 2002 RSNA scientific assembly. Received February 3, 2003; revision requested April 29 and received June 30; accepted July 2. Address corresponcence to G.P.R. (e-mail: gautham.reddy@radiology.ucsf.edu).

View larger version (113K): [in a new window]   Figure 1a.  Normal pericardium. Axial contrast-enhanced CT scan (a) and axial ECG-gated spin-echo (SE) MR image (b) show a pericardium with normal thickness (arrows). Note the epicardial and anterior mediastinal fat outlining the pericardium in b.

View larger version (118K): [in a new window]   Figure 1b.  Normal pericardium. Axial contrast-enhanced CT scan (a) and axial ECG-gated spin-echo (SE) MR image (b) show a pericardium with normal thickness (arrows). Note the epicardial and anterior mediastinal fat outlining the pericardium in b.

View larger version (78K): [in a new window]   Figure 2a.  Normal superior pericardial recess. Axial contrast-enhanced CT scan (a) and ECG-gated SE image (b) show the superior pericardial recess (arrows) in a normal position, posterior to the ascending aorta.

View larger version (114K): [in a new window]   Figure 2b.  Normal superior pericardial recess. Axial contrast-enhanced CT scan (a) and ECG-gated SE image (b) show the superior pericardial recess (arrows) in a normal position, posterior to the ascending aorta.

View larger version (126K): [in a new window]   Figure 3.  Loculated pericardial effusion in a 65-year-old man with recent thoracotomy. Axial contrast-enhanced CT scan shows a loculated pericardial effusion that compresses the right atrium. The parietal pericardium (arrow) clearly separates the loculated pericardial effusion (*) from the pleural effusion (P).

View larger version (135K): [in a new window]   Figure 4.  Pericardial effusion in a 40-year-old woman with shortness of breath. Axial contrast-enhanced CT scan shows an effusion (*) with the same attenuation as water (0 HU).

View larger version (184K): [in a new window]   Figure 5.  Pericardial effusion in a 46-year-old man with shortness of breath. Axial contrast-enhanced CT scan shows a moderate-sized enhancing (35 HU) effusion (*), which was identified at subsequent pericardiocentesis as serosanguineous fluid.

View larger version (142K): [in a new window]   Figure 6.  Pericardial effusion in a 34-year-old woman with nephrotic syndrome. Cine GRE image shows a high-signal-intensity pericardial effusion (*) consistent with nonhemorrhagic fluid.

View larger version (124K): [in a new window]   Figure 7.  Pericardial effusion in a 68-year-old woman with a recent history of myocardial infarction. Axial ECG-gated T1-weighted SE image shows an effusion with high signal intensity (*) suggestive of hemorrhage.

View larger version (124K): [in a new window]   Figure 8.  Constrictive pericarditis in a 55-year-old man who presented with symptoms of heart failure after mediastinal irradiation for Hodgkin lymphoma. Axial contrast-enhanced CT scan shows pericardial thickening (arrows).

View larger version (168K): [in a new window]   Figure 9.  Constrictive pericarditis in a 51-year-old man who presented with symptoms of constriction. Coronal ECG-gated T1-weighted SE image shows abnormally thickened pericardium (arrows) outlined by epicardial and anterior mediastinal fat.

View larger version (127K): [in a new window]   Figure 10a.  Constrictive pericarditis in a 65-year-old man who had had symptoms of right heart failure for 3 months. (a) Axial ECG-gated T1-weighted SE image shows pericardial thickening (arrows), which is most visible near the right ventricle. The right ventricle has a narrow tubular shape secondary to pericardial constriction. (b) Axial T1-weighted SE image obtained at a level slightly caudad to that in a shows dilatation of the inferior vena cava (IVC) and ascites (*).

View larger version (129K): [in a new window]   Figure 10b.  Constrictive pericarditis in a 65-year-old man who had had symptoms of right heart failure for 3 months. (a) Axial ECG-gated T1-weighted SE image shows pericardial thickening (arrows), which is most visible near the right ventricle. The right ventricle has a narrow tubular shape secondary to pericardial constriction. (b) Axial T1-weighted SE image obtained at a level slightly caudad to that in a shows dilatation of the inferior vena cava (IVC) and ascites (*).

View larger version (129K): [in a new window]   Figure 11.  Constrictive pericarditis in a 37-year-old man who presented with shortness of breath 20 years after undergoing irradiation for lymphoma. Axial ECG-gated T1-weighted SE image shows focal pericardial thickening over the right ventricle and right atrium (arrows). The right ventricle (RV) has a tubular shape caused by constriction.

View larger version (171K): [in a new window]   Figure 12.  Constrictive pericarditis in a 45-year-old man with a history of hemopericardium. Axial contrast-enhanced CT scan shows dense pericardial calcification (arrows).

View larger version (141K): [in a new window]   Figure 13.  Infectious pericarditis in a 59-year-old woman with shortness of breath and chest pain. Axial contrast-enhanced CT scan shows enhancement of the pericardium (arrows), indicative of inflammation. Note the associated small pericardial effusion and large bilateral pleural effusions (P). Findings at subsequent pericardiocentesis confirmed exudative effusion.

View larger version (141K): [in a new window]   Figure 14a.  Effusive constrictive pericarditis secondary to viral infection in a 65-year-old man with symptoms of heart failure. (a) Axial ECG-gated T1-weighted SE image shows a crescent-shaped area of intermediate signal intensity (arrows) surrounding the ventricles, which indicates either pericardial thickening or pericardial effusion. (b) Axial gadolinium-enhanced fat-saturated T1-weighted SE image shows marked thickening and enhancement in the pericardium (arrows), findings consistent with inflammation. A moderate-sized pericardial effusion is also depicted.

View larger version (154K): [in a new window]   Figure 14b.  Effusive constrictive pericarditis secondary to viral infection in a 65-year-old man with symptoms of heart failure. (a) Axial ECG-gated T1-weighted SE image shows a crescent-shaped area of intermediate signal intensity (arrows) surrounding the ventricles, which indicates either pericardial thickening or pericardial effusion. (b) Axial gadolinium-enhanced fat-saturated T1-weighted SE image shows marked thickening and enhancement in the pericardium (arrows), findings consistent with inflammation. A moderate-sized pericardial effusion is also depicted.

View larger version (146K): [in a new window]   Figure 15.  Effusive constrictive pericarditis secondary to Mycobacterium tuberculosis in a 44-year-old man with symptoms of heart failure. Axial gadolinium-enhanced ECG-gated fat-saturated T1-weighted SE image shows an enhancing thickened pericardium (arrows) and a moderate-sized pericardial effusion (*).

View larger version (126K): [in a new window]   Figure 16a.  Inflammatory constrictive pericarditis in an 8-year-old boy with progressive shortness of breath after undergoing surgical repair of an atrial septal defect. Axial ECG-gated T1-weighted SE image (a) and axial gadolinium-enhanced fat-saturated T1-weighted SE image (b) show an abnormally thickened pericardium (arrows in a) that enhances after gadolinium administration (arrows in b).

View larger version (137K): [in a new window]   Figure 16b.  Inflammatory constrictive pericarditis in an 8-year-old boy with progressive shortness of breath after undergoing surgical repair of an atrial septal defect. Axial ECG-gated T1-weighted SE image (a) and axial gadolinium-enhanced fat-saturated T1-weighted SE image (b) show an abnormally thickened pericardium (arrows in a) that enhances after gadolinium administration (arrows in b).

View larger version (108K): [in a new window]   Figure 17a.  Pericardial cyst in an asymptomatic 68-year-old man. (a) Axial unenhanced CT scan shows a homogeneous mass (arrows) that has the same attenuation as water, adjacent to the pulmonary artery. (b) Axial contrast-enhanced CT scan shows no enhancement of this mass, a characteristic consistent with pericardial cyst.

View larger version (127K): [in a new window]   Figure 17b.  Pericardial cyst in an asymptomatic 68-year-old man. (a) Axial unenhanced CT scan shows a homogeneous mass (arrows) that has the same attenuation as water, adjacent to the pulmonary artery. (b) Axial contrast-enhanced CT scan shows no enhancement of this mass, a characteristic consistent with pericardial cyst.

View larger version (136K): [in a new window]   Figure 18a.  Pericardial cyst in an asymptomatic 56-year-old man. (a) Axial ECG-gated T1-weighted SE image shows a mass (*) with intermediate signal intensity, adjacent to the main pulmonary artery. (b) Axial gadolinium-enhanced T1-weighted image obtained at the same level as a shows no enhancement of the mass (*) after administration of gadolinium. (c) Axial T2-weighted fast SE image shows a mass (*) with homogeneous high signal intensity. PA = pulmonary artery.

View larger version (135K): [in a new window]   Figure 18b.  Pericardial cyst in an asymptomatic 56-year-old man. (a) Axial ECG-gated T1-weighted SE image shows a mass (*) with intermediate signal intensity, adjacent to the main pulmonary artery. (b) Axial gadolinium-enhanced T1-weighted image obtained at the same level as a shows no enhancement of the mass (*) after administration of gadolinium. (c) Axial T2-weighted fast SE image shows a mass (*) with homogeneous high signal intensity. PA = pulmonary artery.

View larger version (133K): [in a new window]   Figure 18c.  Pericardial cyst in an asymptomatic 56-year-old man. (a) Axial ECG-gated T1-weighted SE image shows a mass (*) with intermediate signal intensity, adjacent to the main pulmonary artery. (b) Axial gadolinium-enhanced T1-weighted image obtained at the same level as a shows no enhancement of the mass (*) after administration of gadolinium. (c) Axial T2-weighted fast SE image shows a mass (*) with homogeneous high signal intensity. PA = pulmonary artery.

View larger version (136K): [in a new window]   Figure 19a.  Organized pericardial hematoma in a 70-year-old woman with a history of coronary artery disease and angioplasty of the right coronary artery. (a) Axial ECG-gated T1-weighted SE image shows a mass (M) with heterogeneous signal intensity in the right atrioventricular groove. (b) Axial gadolinium-enhanced T1-weighted image shows no enhancement of the mass (M). (c, d) Magnitude (c) and phase velocity-encoded (d) cine images show no blood flow in the mass (M), a finding indicative of hematoma rather than pseudoaneurysm.

View larger version (143K): [in a new window]   Figure 19b.  Organized pericardial hematoma in a 70-year-old woman with a history of coronary artery disease and angioplasty of the right coronary artery. (a) Axial ECG-gated T1-weighted SE image shows a mass (M) with heterogeneous signal intensity in the right atrioventricular groove. (b) Axial gadolinium-enhanced T1-weighted image shows no enhancement of the mass (M). (c, d) Magnitude (c) and phase velocity-encoded (d) cine images show no blood flow in the mass (M), a finding indicative of hematoma rather than pseudoaneurysm.

View larger version (121K): [in a new window]   Figure 19c.  Organized pericardial hematoma in a 70-year-old woman with a history of coronary artery disease and angioplasty of the right coronary artery. (a) Axial ECG-gated T1-weighted SE image shows a mass (M) with heterogeneous signal intensity in the right atrioventricular groove. (b) Axial gadolinium-enhanced T1-weighted image shows no enhancement of the mass (M). (c, d) Magnitude (c) and phase velocity-encoded (d) cine images show no blood flow in the mass (M), a finding indicative of hematoma rather than pseudoaneurysm.

View larger version (134K): [in a new window]   Figure 19d.  Organized pericardial hematoma in a 70-year-old woman with a history of coronary artery disease and angioplasty of the right coronary artery. (a) Axial ECG-gated T1-weighted SE image shows a mass (M) with heterogeneous signal intensity in the right atrioventricular groove. (b) Axial gadolinium-enhanced T1-weighted image shows no enhancement of the mass (M). (c, d) Magnitude (c) and phase velocity-encoded (d) cine images show no blood flow in the mass (M), a finding indicative of hematoma rather than pseudoaneurysm.

View larger version (151K): [in a new window]   Figure 20a.  Chronic organized pericardial hematoma in a 39-year-old man who presented with syncope and chest discomfort and had a history of blunt chest trauma 8 years prior. (a) Axial ECG-gated T1-weighted SE image shows a well-circumscribed mass (M) with intermediate signal intensity in the left atrioventricular groove; the mass compresses the left atrium and ventricle. (b) Axial cine GRE image shows a mass (M) with low-signal-intensity foci and a low-signal-intensity rim (arrows), which are indicative of central and peripheral calcifications. These findings were confirmed at subsequent surgery.

View larger version (152K): [in a new window]   Figure 20b.  Chronic organized pericardial hematoma in a 39-year-old man who presented with syncope and chest discomfort and had a history of blunt chest trauma 8 years prior. (a) Axial ECG-gated T1-weighted SE image shows a well-circumscribed mass (M) with intermediate signal intensity in the left atrioventricular groove; the mass compresses the left atrium and ventricle. (b) Axial cine GRE image shows a mass (M) with low-signal-intensity foci and a low-signal-intensity rim (arrows), which are indicative of central and peripheral calcifications. These findings were confirmed at subsequent surgery.

View larger version (156K): [in a new window]   Figure 21.  Metastatic pericardial lymphoma in a 36-year-old man. Axial contrast-enhanced CT scan shows a large heterogeneous anterior mediastinal mass (M) with central necrosis, which has invaded the pericardium (arrowheads). A moderate-sized pericardial effusion (*) and associated enhancement of the pericardium (arrow) also are evident.

View larger version (135K): [in a new window]   Figure 22.  Biopsy-proved primary pericardial mesothelioma in a 60-year-old man with fatigue and dyspnea on exertion. Axial contrast-enhanced CT scan shows a large pericardial effusion (*) and no pericardial nodules. Pericardial nodules occur in this disease but are rare.

View larger version (118K): [in a new window]   Figure 23.  Biopsy-proved primary pericardial lymphoma in a 45-year-old man with shortness of breath. Axial contrast-enhanced CT scan shows an irregular enhanced soft-tissue mass (*) that has infiltrated the entire pericardium.

View larger version (162K): [in a new window]   Figure 24.  Biopsy-proved primary pericardial sarcoma in an asymptomatic 57-year-old man. Axial contrast-enhanced CT scan shows an enhanced soft-tissue mass (*) in the pericardium adjacent to the left atrial appendage.

View larger version (117K): [in a new window]   Figure 25a.  Congenital absence of the pericardium. Axial contrast-enhanced CT scan (a) and ECG-gated T1-weighted SE image (b) show interposition of lung tissue between the aorta and the main segment of the pulmonary artery (arrow), indicating the absence of the pericardium in this area. Note the rotation of the heart toward the left.

View larger version (136K): [in a new window]   Figure 25b.  Congenital absence of the pericardium. Axial contrast-enhanced CT scan (a) and ECG-gated T1-weighted SE image (b) show interposition of lung tissue between the aorta and the main segment of the pulmonary artery (arrow), indicating the absence of the pericardium in this area. Note the rotation of the heart toward the left.