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Constrictive Calcific Pericarditis Causing Coronary Artery Compression

2021; Radiological Society of North America; Volume: 299; Issue: 3 Linguagem: Inglês

10.1148/radiol.2021203726

1527-1315

Rengarajan Rajagopal, Sreenivasa Narayana Raju,

Infective Endocarditis Diagnosis and Management

HomeRadiologyVol. 299, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyConstrictive Calcific Pericarditis Causing Coronary Artery CompressionRengarajan Rajagopal , Sreenivasa Narayana RajuRengarajan Rajagopal , Sreenivasa Narayana RajuAuthor AffiliationsFrom the Department of Radiodiagnosis, Sawai Man Singh Medical College and Attached Hospitals, Jaipur, Rajasthan, India 302004 (R.R.); and Department of Car diovascular Radiology, All India Institute of Medical Sciences, New Delhi, India (S.N.R.).Address correspondence to R.R. (e-mail: [email protected]).Rengarajan Rajagopal Sreenivasa Narayana RajuPublished Online:Apr 6 2021https://doi.org/10.1148/radiol.2021203726MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 47-year-old man presented with progressive exertional dyspnea and bilateral lower-limb edema for 4 months. Transthoracic echocardiographic findings were suboptimal because of the presence of pericardial calcification. Cardiac CT angiography showed pericardial thickening and plaque-like circumferential pericardial calcification at the midventricular level, leading to ballooning of the apical segments (“dumbbell” configuration) (Figure). This band also caused compression of the mid segment of the left anterior descending coronary artery (Figure). This pattern of fixed midcavity constriction by a band of pericardial calcification may be seen with tubercular pericarditis (1). Cardiac CT angiography precisely delineates the extent of calcification and myocardial extension and demonstrates compression of coronary arteries to help in patient treatment and surgical planning (Figures E1 and E2 [online]) (2). Release of the constricting band with a subtotal pericardiectomy offers symptomatic relief in such patients with good long-term results.A, Cinematic volume-rendered image (as seen from above) and, B, oblique sagittal view of cardiac CT scan show circumferential calcific pericardial band and ballooning of apical segments of both ventricles with compression of mid segment of left anterior descending artery (arrow).Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: R.R. disclosed no relevant relationships. S.N.R. disclosed no relevant relationships.References1. Bhagia ST, Patel AR, Reul GJ. Coronary obstruction by a calcific pericardial ring. Ann Thorac Surg 2002;74(2):595–597. Crossref, Medline, Google Scholar2. Bogaert J, Francone M. Pericardial disease: value of CT and MR imaging. Radiology 2013;267(2):340–356. Link, Google ScholarArticle HistoryReceived: Sept 12 2020Revision requested: Oct 21 2020Revision received: Nov 3 2020Accepted: Nov 16 2020Published online: Apr 06 2021Published in print: June 2021 FiguresReferencesRelatedDetailsRecommended Articles Transthoracic Echocardiography: Beginner's Guide with Emphasis on Blind Spots as Identified with CT and MRIRadioGraphics2021Volume: 41Issue: 4pp. 1022-1042CT and MR Imaging of Cardiothoracic VasculitisRadioGraphics2018Volume: 38Issue: 4pp. 997-1021Imaging Features of Complications after Coronary Interventions and Surgical ProceduresRadioGraphics2021Volume: 41Issue: 3pp. 699-719Abnormalities of the Coronary Arteries in Children: Looking beyond the OriginsRadioGraphics2017Volume: 37Issue: 6pp. 1665-1678Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential DiagnosisRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 5See More RSNA Education Exhibits Intravenous Nitroglycerin Technique with Cardiac Computed Tomography for Visualizing Occluded Coronary Artery Filled by CollateralsDigital Posters2019Spontaneous Coronary Artery Dissection (scad): An Uncommon Diagnosis Of A Common PresentationDigital Posters2021Heart Of Stone: Dismystifying Incidental Cardiac Calcification On Computed Tomography.Digital Posters2021 RSNA Case Collection Anomalous origin of the right coronary artery from the left sinus of ValsalvaRSNA Case Collection2020Milk of Calcium Pericardial EffusionRSNA Case Collection2021Milk of Calcium Pericardial EffusionRSNA Case Collection2021 Vol. 299, No. 3 Supplemental MaterialMetrics Altmetric Score PDF download