31 Pericardial Diseases
With Christian J. Kellenberger
- Pericardial diseases include the following:
- • Congenital pericardial defects
- • Pericarditis and pericardial effusion
- • Pneumopericardium
- • Pericardial mass
Congenital Pericardial Defects
Classification
- Total or partial defects
- Left-sided defects more common when partial
- Small percent associated with intracardiac anomalies
Clinical Manifestations
- Complete defects almost always asymptomatic
- Partial defects may present with intermittent chest pain, and rarely herniation of the left atrial appendage may become incarcerated, which is life threatening.
Chest Radiographic Findings
- In complete absence of the pericardium, the heart is rotated leftward and is displaced away from the sternum and diaphragm.
- Prominence of main pulmonary artery
- Lung wedges between aorta and pulmonary artery
- Lung interposed between heart and hemidiaphragm
- Normal position of trachea and descending aorta
- Partial defects: focal prominence of left atrial appendage along the left upper heart border
Pericardial Effusions and Pericarditis
Pathophysiology
- Most common causes of pericardial effusions are infectious and iatrogenic.
- Less common causes of pericardial effusions are neoplastic and connective tissue disorders.
- Infectious pericarditis most commonly viral, less commonly bacterial, tuberculous, or fungal
- Large pericardial effusion caused by bacterial pericarditis, malignancy, immune disorders, and sometimes never determined
- Constrictive pericarditis with adherent, thickened, fibrotic pericardium restricting diastolic filling of all chambers
- Pericardial effusion may complicate postoperative course with an unexplained enlargement of the cardiac silhouette size in a short interval.
- Postpericardotomy syndrome is postulated to be an autoimmune response, perhaps triggered by a viral infection, 1 to 6 weeks following surgery in which the pericardial cavity has been entered with development of pericardial effusions.
Clinical Manifestations