Let's Chat About… Perplexing Pericardiums” Interesting CMR Cases-Let's Chat About… Perplexing Pericardiums” Interesting CMR Cases

Video Transcription

Video Summary

This webinar featured two challenging pericardial cases and highlighted the value of multimodality cardiac imaging.<br /><br />The first case involved a 17-year-old with progressive fatigue, weight loss, cough, and dyspnea after travel to West Africa and treatment for malaria. Imaging showed severe pericardial thickening, pleural effusions, and constrictive physiology. Cardiac MRI demonstrated marked septal shift, circumferential pericardial adherence, late gadolinium enhancement, and biventricular systolic dysfunction. Feature-tracking strain showed regional impairment greatest where the pericardium was most tethered to the myocardium. The patient underwent pericardiectomy and right pleural decortication, with immediate improvement in ventricular function. Pathology confirmed tuberculosis of the pericardium. The panel emphasized MRI’s role in diagnosing constrictive pericarditis and avoiding invasive catheterization.<br /><br />The second case was a 60-year-old woman with cough, dyspnea, chest pain, pericardial effusion, and a posterior pericardial mass. CT suggested fat density, and MRI confirmed a pericardial lipoma with concurrent pericarditis. After empiric anti-tubercular therapy, the effusion resolved and the mass became smaller, likely due to its malleability. The discussion covered pericardial enhancement, tissue characterization, strain, tagging, T1/T2 mapping, and the difficulty of distinguishing pericardial fluid, thickening, and mass lesions.

Keywords

pericardial cases

multimodality cardiac imaging

constrictive pericarditis

cardiac MRI

pericardial tuberculosis

pericardiectomy

pericardial lipoma

pericardial effusion

tissue characterization