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
