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Cardiac CT and MRI scans: cross-sectional imaging with computed tomography (CT) can help localize and quantify the effusion, especially in a loculated effusion (an effusion contained to one area). [12] CT imaging also helps assess for pericardial pathology (pericardial thickening, constrictive pericarditis, malignancy-associated pericarditis). [1]
The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart. This procedure has significant risk involved, [ 14 ] with mortality rates of 6% or higher in major referral centers.
The condition has four stages of disease which manifests with clinical presentations ranging from acute pericarditis to overt heart failure. [3] Tuberculous pericarditis is an under-diagnosed condition. [3] Diagnosis often requires a range of diagnostic tools, including pericardiocentesis, biochemical tests, and imaging.
Purulent Pericarditis; Echocardiogram showing pericardial effusion with signs of cardiac tamponade: Specialty: Cardiology: Symptoms: substernal chest pain (exacerbated supine and with breathing deeply), dyspnea, fever, rigors/chills, and cardiorespiratory signs (i.e., tachycardia, friction rub, pulsus paradoxus, pericardial effusion, cardiac tamponade, pleural effusion)
Cardiac CT (CCT) is a modified form of the traditional chest CT due to the difficulty of imaging the complex, moving heart. [16] This is achieved through the use of thin slices and high-resolution scanning, as well as the addition of electrocardiogram (ECG) gating or triggering to capture a motion-free image.
The pericardium (pl.: pericardia), also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. [1] It has two layers, an outer layer made of strong inelastic connective tissue (fibrous pericardium), and an inner layer made of serous membrane (serous pericardium).
On a chest X-ray, the normal heart silhouette should have a clear and defined outline. However, in cases of pericardial effusion, the accumulation of fluid within the pericardial sac causes the heart to appear enlarged and assumes a shape that is reminiscent of a water bottle, with relatively smooth cardiac contours. [2]
Pericardial cysts that are small and cause no symptoms can be followed with repeat imaging through echocardiogram, CT, or MRI to assess for changes. [1] [2] Pericardial cysts that are large or cause symptoms may be candidates for percutaneous aspiration, ethanol sclerosis, or surgery.