ciculatory

7/28/2019 ciculatory

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CI RCULAT OR Y

S Y S T EM


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PERI CARDI AL EFFUSI ON

Pericardial effusion originates in theobstruction of venous or lymphaticdrainage from the heart.

Common causes of pericardialeffusion include heart failure, renalinsufficiency, infection (bacterial,viral, or tuberculous), neoplasm

(carcinoma of lung or breast, orlymphoma), and injury (from traumaor myocardial infarction).


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Loculated pericardial effusion in a 65- year-old man with recent thoracotomy.Axial contrast-enhanced CT scan showsa loculated pericardial effusion thatcompresses the right atrium. Theparietal pericardium (arrow) clearlyseparates the loculated pericardialeffusion (*) from the pleural effusion(P ).


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Pericardial effusion in a 40-year-old woman with shortness ofbreath. Axial contrast-enhancedCT scan shows an effusion (*) withthe same attenuation as water (0HU).


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Pericardial effusion in a 46-year-old man with shortness of breath.Axial contrast-enhanced CT scan

shows a moderate-sizedenhancing (35 HU) effusion (*),which was identified at

subsequent pericardiocentesis asserosanguineous fluid.


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Pericardial effusion in a 34-year-oldwoman with nephrotic syndrome.Cine GRE image shows a high-signal-intensity pericardial effusion (*)consistent with nonhemorrhagicfluid .


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Pericardial effusion in a 68-year-old woman with a recent history ofmyocardial infarction. Axial ECG-gated T1-weighted SE image showsan effusion with high signalintensity (*) suggestive ofhemorrhage.


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CONSTRICTI VEPERICARDI TI S

Symptoms are heart failure, such asdyspnea, orthopnea, and fatigability,and occasionally may present with

liver enlargement and ascites. The most frequent causes are cardiacsurgery and radiation therapy.

Other causes include infection (viralor tuberculous), connective-tissuedisease, uremia, neoplasm, oridiopathic condition


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Constrictive pericarditis in a 51- year-old man who presentedwith symptoms of constriction.

Coronal ECG-gated T1-weightedSE image shows abnormallythickened pericardium (arrows)

outlined by epicardial and anterior mediastinal fat.


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Constrictive pericarditis in a 65-year-old

man who had had symptoms of right heartfailure for 3 months. (a) Axial ECG-gatedT1-weighted SE image shows pericardialthickening (arrows), which is most visible

near the right ventricle. The rightventricle has a narrow tubular shapesecondary to pericardial constriction. (b) Axial T1-weighted SE image obtained at alevel slightly caudad to that in a showsdilatation of the inferior vena cava ( IVC )and ascites (*).


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Constrictive pericarditis in a 37- year-old man who presented withshortness of breath 20 years afterundergoing irradiation for lymphoma.

Axial ECG-gated T1-weighted SEimage shows focal pericardialthickening over the right ventricleand right atrium (arrows). The rightventricle ( RV ) has a tubular shapecaused by constriction.


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Constrictive pericarditis ina 45-year-old man with ahistory of

hemopericardium. Axialcontrast-enhanced CT scanshows dense pericardial

calcification (arrows).


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PERICARDITIS WITH CONSTRICTION

Pericardial thickening may occur inthe absence of constrictivepericarditis.

Pericardial thickening may resultfrom inflammation caused by avariety of conditions, including acutepericarditis, uremia, rheumatic heart

disease, rheumatoid arthritis,sarcoidosis, and mediastinalirradiation.


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Infectious pericarditis in a 59-year-old

woman with shortness of breath andchest pain. Axial contrast-enhanced CT scan shows enhancement of thepericardium (arrows), indicative ofinflammation. Note the associated smallpericardial effusion and large bilateralpleural effusions ( P ). Findings at

subsequent pericardiocentesisconfirmed exudative effusion.


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Effusive constrictive pericarditissecondary to Mycobacteriumtuberculosis in a 44-year-old manwith symptoms of heart failure.

Axial gadolinium-enhanced ECG-gated fat-saturated T1-weightedSE image shows an enhancingthickened pericardium (arrows)and a moderate-sized pericardialeffusion (*).


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Inflammatory constrictive pericarditis inan 8-year-old boy with progressiveshortness of breath after undergoingsurgical 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) showan abnormally thickened pericardium(arrows in a ) that enhances aftergadolinium administration (arrows in b).


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PERICARDIAL MASSES The differential diagnosis of pericardial

masses includes pericardial cyst,hematoma, and neoplasm

It is often detected initially withechocardiography, CT and MR imagingare useful for the further evaluation of these masses.


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CYST S

Congenital pericardial cysts areformed when a portion of thepericardium is pinched off duringearly development.

Pericardial cysts usually have thinsmooth walls without internal septa. At CT, they have the same

attenuation as water and do notenhance after contrast materialadministration.

At MR imaging, they typically havelow or intermediate signal intensity onT1-weighted images and homogeneous


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Pericardial cyst in an asymptomatic

68-year-old man. (a) Axialunenhanced CT scan shows ahomogeneous mass (arrows) that hasthe same attenuation as water,adjacent to the pulmonary artery. (b) Axial contrast-enhanced CT scanshows no enhancement of this mass, acharacteristic consistent withpericardial cyst.


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HEMAT OMAS

Acute hematomas demonstratehomogeneous high signal intensity,whereas subacute hematomas that

are 1

4 weeks old typically showheterogeneous signal intensity, withareas of high signal intensity on bothT1-weighted and T2-weighted images.


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Organized pericardial hematoma in a 70-year-old woman with a history of coronary arterydisease and angioplasty of the right coronaryartery. (a) Axial ECG-gated T1-weighted SEimage shows a mass (M) with heterogeneoussignal intensity in the right atrioventriculargroove. (b) Axial gadolinium-enhanced T1-weighted image shows no enhancement of themass (M). (c, d) Magnitude (c) and phasevelocity-encoded (d) cine images show no bloodflow in the mass (M), a finding indicative ofhematoma rather than pseudoaneurysm.


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Chronic organized pericardial hematoma in a 39- year-old man who presented with syncope andchest discomfort and had a history of blunt chesttrauma 8 years prior. (a) Axial ECG-gated T1-weighted SE image shows a well-circumscribedmass (M ) with intermediate signal intensity in the

left atrioventricular groove; the mass compressesthe left atrium and ventricle. (b) Axial cine GREimage shows a mass ( M ) with low-signal-intensityfoci and a low-signal-intensity rim (arrows), which

are indicative of central and peripheralcalcifications. These findings were confirmed atsubsequent surgery.


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NEOPLASM

Pericardial metastases are much morecommon than primary pericardialtumors and are discovered at autopsyin 10% 12% of all patients with

malignancy Tumors may seed the pericardium viathe lymph system or the blood streamor may invade directly from the lung

or mediastinum Breast and lung cancers are the mostcommon sources of metastases in thepericardium, followed by lymphomasand melanomas


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Metastatic pericardial lymphoma in a 36- year-old man. Axial contrast-enhanced CT scan shows a large heterogeneousanterior mediastinal mass ( M ) with

central necrosis, which has invaded thepericardium (arrowheads). A moderate-sized pericardial effusion (*) andassociated enhancement of thepericardium (arrow) also are evident.


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CONGENITAL ABSENCE OF THE PERICARDIUM

Congenital absence of the pericardium is rare.Most pericardial defects are partial and occuron the left side.

Infrequently, defects also occur on the rightside or at the diaphragmatic surface

Left-sided absence of the pericardium allowsinterposition of lung tissue between the aortaand the main segment of the pulmonary artery,and, occasionally, bulging of the left atrialappendage through the defect.

As a result of these abnormalities, the heartusually rotates toward the left.


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Congenital absence of the pericardium.

Axial contrast-enhanced CT scan (a) andECG-gated T1-weighted SE image (b) show interposition of lung tissue betweenthe aorta and the main segment of thepulmonary artery (arrow), indicating theabsence of the pericardium in this area.Note the rotation of the heart toward

the left.

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