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Constrictive pericarditis at abdominal CT: a commonly overlooked diagnosis
Kristina T Johnson1, Paul R Julsrud, C Daniel Johnson
1Department of Radiology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
Abdominal Imaging
|May 19, 2007
Summary
Abdominal CT scans can reveal indirect signs of constrictive pericarditis, such as dilated IVC and ascites. Retrospective review of CT scans is more effective than prospective review for identifying these pericardial abnormalities.
Area of Science:
- Radiology
- Cardiology
- Gastroenterology
Background:
- Constrictive pericarditis is a serious cardiac condition.
- Abdominal symptoms can be the primary presentation of constrictive pericarditis.
- Computed tomography (CT) is a key imaging modality.
Purpose of the Study:
- To evaluate abdominal CT findings in patients with constrictive pericarditis.
- To determine the diagnostic accuracy of CT for constrictive pericarditis.
- To identify indirect CT signs suggestive of constrictive pericarditis.
Main Methods:
- Retrospective review of medical records and abdominal CT scans from 25 patients with surgically proven constrictive pericarditis.
- Collating clinical symptoms, laboratory findings, and prospective CT findings.
- Unblinded retrospective analysis of CT examinations.
Main Results:
- Abnormal pericardial findings (thickening or calcification) were identified in 23/25 patients on retrospective review.
- Indirect CT findings included dilated inferior vena cava (IVC) in 20/25 patients and dilated hepatic veins in 14/25 patients.
- Other common findings were ascites (14/25), mesenteric stranding (12/25), and cirrhosis (6/25). Anemia (17/25) and elevated AST (12/25) were frequent laboratory abnormalities.
Conclusions:
- Constrictive pericarditis can manifest with subtle abdominal symptoms.
- Indirect CT findings like dilated IVC/hepatic veins, ascites, or cirrhosis warrant pericardial evaluation.
- Retrospective CT review is crucial for identifying pericardial abnormalities, often missed prospectively.
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