Answer for BIR CoW 07 Dec 2025
Tuberculous constrictive pericarditis
Findings
Diffuse pericardial thickening with contrast enhancement noted measuring 7 mm in thickness. Prominent ivc and hepatic veins. Interventricular septum measures 7.4 mm. Right ventricular outflow tract diameter – 2.1 cm. Multiple right upper paratracheal and subcarinal lymph nodes with rim enhancement noted. Paradoxical wall septal motion noted.
Discussion
Constrictive pericarditis (CP) is a chronic inflammatory condition in which a fibrotic, thickened, or calcified pericardium restricts normal diastolic filling. Imaging plays a central role in diagnosis because clinical findings overlap with restrictive cardiomyopathy. CT is highly sensitive for detecting pericardial thickening (>2 mm), calcification, and pericardial adhesions, which are hallmarks of chronic constriction. CT reliably shows crescentic or circumferential thickening, often with patchy or dense calcification, most frequently along the right ventricle, diaphragmatic surface, and AV grooves. The presence of normal pericardial thickness does not exclude CP, as up to 20% of proven cases may have a normal-thickness but non-compliant pericardium. MRI adds important functional information because it directly demonstrates the pathophysiology of ventricular coupling. Classic MRI findings include septal bounce, exaggerated ventricular interdependence, and respiratory-related interventricular septal shift, reflecting rigid pericardial constraint. Tagged MRI sequences can show pericardial-myocardial adhesion, while cine SSFP sequences demonstrate abrupt early diastolic filling followed by rapid cessation (“square root sign”). Late gadolinium enhancement may reveal active pericardial inflammation, which helps predict response to anti-inflammatory therapy.
References:
Talreja DR, Nishimura RA, Oh JK, Holmes DR. Constrictive pericarditis in the modern era: novel criteria for diagnosis in the cardiac catheterization laboratory. Circulation. 2008. Bogaert J, Francone M. Cardiac MRI in constrictive pericarditis. JACC Cardiovasc Imaging. 2011. Weber HS. Diagnosis of constrictive pericarditis by CT and MRI. Radiographics. 2007.
Findings
Diffuse pericardial thickening with contrast enhancement noted measuring 7 mm in thickness. Prominent ivc and hepatic veins. Interventricular septum measures 7.4 mm. Right ventricular outflow tract diameter – 2.1 cm. Multiple right upper paratracheal and subcarinal lymph nodes with rim enhancement noted. Paradoxical wall septal motion noted.
Discussion
Constrictive pericarditis (CP) is a chronic inflammatory condition in which a fibrotic, thickened, or calcified pericardium restricts normal diastolic filling. Imaging plays a central role in diagnosis because clinical findings overlap with restrictive cardiomyopathy. CT is highly sensitive for detecting pericardial thickening (>2 mm), calcification, and pericardial adhesions, which are hallmarks of chronic constriction. CT reliably shows crescentic or circumferential thickening, often with patchy or dense calcification, most frequently along the right ventricle, diaphragmatic surface, and AV grooves. The presence of normal pericardial thickness does not exclude CP, as up to 20% of proven cases may have a normal-thickness but non-compliant pericardium. MRI adds important functional information because it directly demonstrates the pathophysiology of ventricular coupling. Classic MRI findings include septal bounce, exaggerated ventricular interdependence, and respiratory-related interventricular septal shift, reflecting rigid pericardial constraint. Tagged MRI sequences can show pericardial-myocardial adhesion, while cine SSFP sequences demonstrate abrupt early diastolic filling followed by rapid cessation (“square root sign”). Late gadolinium enhancement may reveal active pericardial inflammation, which helps predict response to anti-inflammatory therapy.
References:
Talreja DR, Nishimura RA, Oh JK, Holmes DR. Constrictive pericarditis in the modern era: novel criteria for diagnosis in the cardiac catheterization laboratory. Circulation. 2008. Bogaert J, Francone M. Cardiac MRI in constrictive pericarditis. JACC Cardiovasc Imaging. 2011. Weber HS. Diagnosis of constrictive pericarditis by CT and MRI. Radiographics. 2007.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!