Imaging
Pericarditis
- Preliminary Diagnosis: Pericarditis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of pericarditis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pericarditis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Pericarditis
I. What imaging technique is first-line for this diagnosis?
Transthoracic echocardiography
II. Describe the advantages and disadvantages of this technique for diagnosis of pericarditis.
Advantages
Does not use ionizing radiation
Can determine life-threatening consequences such as pericardial tamponade
Useful to diagnose myocarditis and ventricular dysfunction, which could change the management approach
Disadvantages
Not sensitive to detect pericardial thickening in acute pericarditis and may be interpreted as normal in the absence of pleural effusion
Poor chest windows due to body habitus or chest wall abnormalities leads to poor image acquisition and evaluation
Loculated pleural effusions may not be detected
III. What are the contraindications for the first-line imaging technique?
None
IV. What alternative imaging techniques are available?
CT with and without IV contrast
MRI with and without IV contrast
Plain-film radiographs
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pericarditis.
CT with and without IV contrast
Advantages
Demonstrates pericardial effusion and thickening (>4-6 mm)
Evaluating the density of the pericardial effusion can aide in diagnosis
Pericardial enhancement suggests active inflammation
Evaluates the entire pericardium
Disadvantages
Exposure to ionizing radiation
Risk of contrast-inducted nephropathy
Can not differentiate if pericardial thickening is constrictive or nonconstrictive
MRI with and without IV contrast
Advantages
Determines if an effusion is simple or complicated (hemorrhagic)
Pericardial enhancement suggests active inflammation
Highly sensitive to differentiate constrictive from restrictive cardiomyopathy
Disadvantages
Expensive
Time consuming
Requires significant patient cooperation to minimize motion artifact
Risk of nephrogenic systemic fibrosis in patient with poor renal function
Plain-film radiographs
Advantages
May demonstrate egg-shell calcifications
Can show signs of concurrent heart failure, pneumonia, or neoplasm
Fast and economic screening examination
Disadvantages
Often normal in uncomplicated acute idiopathic pericarditis
Small to moderate sized effusions may not cause an abnormal cardiac silhouette
VI. What are the contraindications for the alternative imaging techniques?
CT with and without IV contrast
Renal failure (risk of contrast-induced nephropathy with iodinated contrast)
Pregnancy
Contrast allergy may be a relative contraindication
MRI with and without IV contrast
Renal failure (risk of nephrogenic systemic fibrosis with gadolinium)
Metallic foreign bodies or implanted devices that are not MRI compliant
Pregnancy during the first trimester may be a relative contraindication
Plain-film radiographs
No significant contraindications exist. Some institutions may require consent for pregnant patients.
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