Acute Fibrinous Pericarditis Assessed With Magnetic Resonance Imaging
A 55-year-old woman was admitted to our institution because of progressive right heart failure and purulent pericardial effusion. Echocardiography, limited by poor image quality, revealed a small (14 mm in systole), hemodynamically insignificant pericardial effusion. Magnetic resonance cine images showed reduced volumes of both ventricles (left ventricle, 62 mL; right ventricle, 58 mL in end diastole) and normal ejection fraction but paradoxical movement of the atrial and ventricular septum (Movie). The pericardium was thickened (maximum thickness 8 mm), and a pericardial effusion (10 mm) was visible. The T1-weighted spin echo images confirmed the pericardial findings (Figure 1); additionally, a dilated inferior caval vein and pleural effusions were seen. Spin echo and inversion recovery gradient echo images (Figure 2) showed an increased uptake of contrast agent (Gd-DTPA) in the visceral and parietal layers of the pericardium and possibly the epicardium, which is a sign of active inflammation. During surgery (decortication), elevated pulmonary and left atrial pressures dropped considerably. The epicardium was covered with whitish granulomatous tissue and cloudy fluid. Pericardial histology showed a severe florid fibrinous and chronic granulomatous inflammation without identification of an infectious agent.
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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