Correct!
5. All of the above.
Pericardial calcification strongly suggests constrictive pericarditis when attempting to separate constrictive pericarditis from restrictive cardiomyopathy. Recently, CMR has become an important test in separating the two entities. CMR is advocated by some as the diagnostic procedure of choice for the detection of certain pericardial diseases, including constrictive pericarditis.
Our patient’s CMR is shown in Figure 3.
Figure 3. Free breathing cardiac magnetic resonance (CMR) images obtained at the cardiac apex, mid-cavity, and base in the short axis plane show early diastolic interventricular septal flattening and leftward motion during inspiration, representing the so-called "septal bounce."
Characteristic CMR features in patients with constrictive pericarditis include increased pericardial thickening and dilatation of the inferior vena cava, an indirect sign of impaired right ventricular diastolic filling and paradoxical motion of the intraventricular septum. In our patient free breathing CMR images were obtained at the cardiac base, mid-cavity, and apex in the short axis plane. These show early diastolic interventricular septal flattening and leftward motion during inspiration, representing the so-called "septal bounce”.
The etiologies of constrictive pericarditis and their relative percentages are shown below (Table 1).
Table 1. Causes and relative percentages of constrictive pericarditis
Cause |
Percentage |
Idiopathic or viral |
42 to 49% |
Post-cardiac surgery |
11 to 37% |
Post-radiation therapy |
9 to 31% |
Connective tissue disorder |
3 to 7% |
Postinfectious (tuberculous or purulent pericarditis) |
3 to 6% |
Miscellaneous causes (malignancy, trauma, drug-induced, asbestosis, sarcoidosis, uremic pericarditis) |
1 to 10% |
In each case an initial inflammation of the pericardium is followed by scarring resulting in the constriction.
Which of the following are appropriate therapies for constrictive pericarditis?