Answer for BIR CoW 26 Dec 2021
Constrictive Pericarditis
Findings
Biatrial dilation and tubular shaped ventricles noted Dilated inferior vena cava and hepatic veins reflecting right heart strain Left pleural effusion Cine TRUFI imaging reveals paradoxical movement of interventricular septum with leftward movement
Discussion
Common Features on Cardiovascular Magnetic Resonance Assessment Associated with Constrictive Pericarditis: Pericardial thickness ≥4 mm, denoted as a dark, low-intensity signal stripe often with distinct fibrocalcific irregularities Elongated, narrowed right ventricle, sometimes described as “tubing of the right ventricle” Right and often, biatrial enlargement Sigmoid-shaped intraventricular septum with abnormal motion Inferior vena cava plethora (and hepatic venous congestion) Pericardial contrast enhancement after intravenous gadolinium-DTPA, where early enhancement suggests associated pericardial inflammation and late enhancement suggests pericardial scar (specific patterns may denote specific etiologies such as that with tuberculous pericarditis) Myocardial tagging showing lack of change in the grid, suggesting tight adhesion between the pericardium and the underlying myocardium
References:
1.The Utility of Cardiovascular Magnetic Resonance in Constrictive Pericardial Disease, Cardiol Rev. 2009 ; 17(2): 77–82. doi:10.1097/CRD.0b013e318197e950.
2.Cardiac MRI: Part 2, Pericardial Diseases, AJR 2011; 197:W621–W634 DOI:10.2214/AJR.10.7265
3.CT and MR Imaging of Pericardial Disease1 Zhen J. Wang, MD,Gautham P. Reddy, MD, MPH,Michael B. Gotway, MD,Benjamin M. Yeh, MD, Steven W. Hetts, MD and Charles B. Higgins, MD
Findings
Biatrial dilation and tubular shaped ventricles noted Dilated inferior vena cava and hepatic veins reflecting right heart strain Left pleural effusion Cine TRUFI imaging reveals paradoxical movement of interventricular septum with leftward movement
Discussion
Common Features on Cardiovascular Magnetic Resonance Assessment Associated with Constrictive Pericarditis: Pericardial thickness ≥4 mm, denoted as a dark, low-intensity signal stripe often with distinct fibrocalcific irregularities Elongated, narrowed right ventricle, sometimes described as “tubing of the right ventricle” Right and often, biatrial enlargement Sigmoid-shaped intraventricular septum with abnormal motion Inferior vena cava plethora (and hepatic venous congestion) Pericardial contrast enhancement after intravenous gadolinium-DTPA, where early enhancement suggests associated pericardial inflammation and late enhancement suggests pericardial scar (specific patterns may denote specific etiologies such as that with tuberculous pericarditis) Myocardial tagging showing lack of change in the grid, suggesting tight adhesion between the pericardium and the underlying myocardium
References:
1.The Utility of Cardiovascular Magnetic Resonance in Constrictive Pericardial Disease, Cardiol Rev. 2009 ; 17(2): 77–82. doi:10.1097/CRD.0b013e318197e950.
2.Cardiac MRI: Part 2, Pericardial Diseases, AJR 2011; 197:W621–W634 DOI:10.2214/AJR.10.7265
3.CT and MR Imaging of Pericardial Disease1 Zhen J. Wang, MD,Gautham P. Reddy, MD, MPH,Michael B. Gotway, MD,Benjamin M. Yeh, MD, Steven W. Hetts, MD and Charles B. Higgins, MD
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!