Correspondence
Diagnosis of Constrictive Pericarditis by Tagged Cine Magnetic Resonance Imaging
N Engl J Med 1999; 341:373-374July 29, 1999
- Article
To the Editor:
Constrictive pericarditis is characterized by a thickened and adherent pericardium that restricts diastolic filling of the heart.1 Although many diagnostic criteria for constrictive pericarditis have been proposed, not all cases necessarily fulfill them.2 Thus, the diagnosis of constrictive pericarditis is sometimes difficult.
We cared for a patient with constrictive pericarditis for whom we used tagged cine magnetic resonance imaging (cine MRI)3 and successfully identified adhesion of the thickened pericardium to the myocardium, which is the essential feature of constrictive pericarditis. Tagged cine MRI is a new, noninvasive imaging technique for labeling and monitoring specific regions of the heart; the patterns of regional displacement accurately reflect the intervening motion within a cardiac cycle.
The patient, a 28-year-old woman, was seen for refractory ascites, which had been present for four years. Her principal symptoms were dyspnea on exertion, abdominal swelling, and edema. On auscultation, a pericardial knock was prominent. A chest film showed mild enlargement of the cardiac silhouette. A computed tomographic scan of the chest showed a thickened pericardium with calcification around the atrioventricular sulcus, a finding consistent with the diagnosis of constrictive pericarditis. The patient had no history of tuberculosis, collagen disease, malignant disease, myocardial infarction, cardiac surgery, or radiation therapy, and therefore the specific cause of the constrictive pericarditis could not be determined. Cardiac catheterization revealed a normal left ventricular ejection fraction and normal coronary arteries; however, the right ventricular and left ventricular end-diastolic pressures were elevated and almost equal (20 and 23 mm Hg, respectively). Recordings of the right and left ventricular pressures had a characteristic “dip and plateau” contour, and a recording of the right atrial pressure had a prominent y descent. MRI of the chest by the T2-weighted spin–echo technique revealed a thickened pericardium around the right and left ventricles (Figure 1Figure 1
T2-Weighted Spin–Echo MRI Scan of the Chest.). More important, tagged cine MRI revealed tight adhesion of the thickened pericardium to the myocardium of the right and left ventricles, indicated by the persistent concordance of tagged signals between the pericardium and the myocardium throughout the diastolic and systolic phases (Figure 2AFigure 2
Tagged Cine MRI Images at End Diastole (Panel A) and End Systole (Panel B). and Figure 2B). The diagnosis of idiopathic constrictive pericarditis was confirmed at surgery and by subsequent histologic examination. After pericardiectomy, the ascites disappeared and the patient had no dyspnea on effort.We conclude that examination for adhesion of the thickened pericardium to the myocardium by tagged cine MRI is a useful and reliable noninvasive method to diagnose constrictive pericarditis.
3 ReferencesSunao Kojima, M.D.
Naoaki Yamada, M.D.
Yoichi Goto, M.D.
National Cardiovascular Center, Osaka 565-8565, Japan1
Lorell BH. Constrictive pericarditis. In: Braunwald E, ed. Heart disease: a textbook of cardiovascular medicine. 5th ed. Philadelphia: W.B. Saunders, 1997:1496-505.
2
Vaitkus PT ,Kussmaul WG . Constrictive pericarditis versus restrictive cardiomyopathy: a reappraisal and update of diagnostic criteria. Am Heart J 1991;122:1431-1441
CrossRef | Web of Science | Medline3
Zerhouni EA ,Parish DM ,Rogers WJ ,Yang A ,Shapiro EP . Human heart: tagging with MR imaging -- a method for noninvasive assessment of myocardial motion. Radiology 1988;169:59-63
Web of Science | Medline
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Monvadi B. Srichai. (2011) CMR Imaging in Constrictive Pericarditis. JACC: Cardiovascular Imaging 4:11, 1192-1194
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