CT Findings of Tuberculous Pericardial Effusion

PURPOSE: To evaluate the CT findings of tuberculous pericardial effusion. MATERIALS AND METHODS: In 12patients with tuberculous pericardial effusion. CT scans were obtained. The condition was diagnosed by thepresence of chronic granulomatous inflammation with caseous granuloma or acid fast bacilli in a biopsy specimen orpericardial fluid. CT findings were evaluated with regard to the appearance and the location of pericardialthickening, location of pericardial effusion, loculation of the pericardial effusion by adhesion of pericardiumand associated findings such as pulmonary tuberculosis or pleural effusion. RESULTS: In all cases, pericardialeffusion and thickening were seen. This thickening was usually even(10 of 12 cases), and occurred mainly in theanterior portion(7 of 12 cases). Thickened pericardium was enhanced and showed higher attenuation than adjacentchest wall muscle. Effusion was usually found in the anterior portion(10 of 12 cases), though the right and leftside were also involved(5/12 and 6/12 cases, respectively). Loculation of pericardial effusion was noted in tencases. Pleural effusion occurred in eight cases and associated active pulmonary tuberculosis in five. CONCLUSION: The CT findings of tuberculous pericardial effusion are enhanced evenly-thickened pericardium and anteriorloculated pericardial effusion, and are helpful for the diagnosis of tuberculous pericardial effusion.

Increased Opacity of Left Pericardiac Area on Chest Radiograph: Correlation with CT Findings and its Frequency

PURPOSE: The purpose of this study was to evaluate the incidcnce of extrapericardial fat in the left cardiacborder, and with regard to left extrapericardial fat, to correlate chest radiographs with CT scans. MATERIALS AND METHODS: This study involved 132 consecutive patients who underwent chest PA and lateral radiographs, and chestCT scans. According to the results of chest PA radiograph, patients were divided into three groups: those with aclear left cardiac border; those with an indistinct left cardiac border; and those with an indistinct left cardiacborder with increased density; cardiophrenic angle, as seen on lateral radiograph, the presence of increaseddensity in the anterior cardiophrenic angle, as seen on lateral radiograph radiographs was evaluated. On the basisof the results of CT scanning, patients were classified into four groups according to the amount of leftextrapericardial fat: negative, minimum, moderate, and maximum. Left extrapericardial fat, as seen on CT, wascorrelated with the conspicuity of left cardiac border seen on PA radiograph and the presence of increased densityin the anterior cardiophrenic angle, as seen on lateral radiograph. RESULTS: On CT, left extrapericardial fat wasobserved in 51 patients (38.6%). In 38 of these (28.8%), the amount was minimal, in 12 (9.1%), it was moderate,and in one (0.8%), it was maximal. On posteroanterior chest radiograph, clear, indistinct, and indistinct andincreased density of the left cardiac border was seen in 89 (67.4%), 28 (21.2%), and 15 cases (11.4%),respectively. On lateral radiograph, increased density of the anterior cardiophrenic angle was seen in 115 cases(87.1%) but in 17 (12.9%), increase density was not apparent. There was significant correlation between chestradiographs and CT(p<0.001) (sensitivity: 53%; specificity: 100%; positive predictive value: 100%; negativepredictive value: 84%). CONCLUSION: The conspicuousness of the left cardiac border, as seen on PA chestradiograph, correlated with the presence of left extrapericardial fat, as seen on CT, and was related to theamount of left extrapericardial fat. Increased density of the anterior cardiophrenic angle, as seen on lateralradiographs, correlated with the presence of left extrapericardial fat on CT, but the absence of increased densityon lateral radiograph corresponds to the absence or a minimal amount of left extrapericardial fat, as seen on CT.

CT Measurement of Normal Pericardial Thickness in Adults on Computed Tomography

PURPOSE: The purpose of this study was to establish, using computed tomography, the normal thickness of thepericardium in adults. MATERIALS AND METHODS: CT scans of 50 patients, including sections through the level of theheart, were reviewed. Patients were excluded if there were any suspicions of pericardial abnormality such asinfectious or neoplastic diseases. Twenty-four of the 50 were men and 26 were women; their mean age was 47.0(range,18-76) years. We measured pericardial thickness at the level of the right ventricle, interventricularseptum and left ventricle, and also compared pericardial thickness in terms of age and sex. RESULTS: In allpatients, the pericardium was observed in the right ventricular region; in 41 (82%) at the interventricularseptum; and in 41 (82%) along the left ventricle. The mean thickness of normal pericardium at the level of theright ventricle, interventricular septum, and left ventricle was 1.8 mm +/- 0.5 mm, 1.8 mm +/- 0.4 mm, and 1.7 mm +/-0.5 mm, respectively. No statistically significant correlation was apparent between pericardial thickness and agegroup (p > 0.63, ANOVA test). Mean pericardial thickness was 1.9 mm +/- 0.6 mm in males and 1.7 mm +/- 0.4 mm in females; thus, no statistically significant correlation was apparent between pericardial thickness and sex (p >0.29, Student's t-test). CONCLUSION: The pericardium was best visualized in sections through the right ventricle.The mean thickness of normal pericardium was 1.8 mm +/- 0.5 mm and pericardial thickness did not differ accordingto age or sex.

Primary Malignant Mesothelioma of the Pericardium: A Case Report

Primary malignant mesothelioma of the pericardium is a very rare and highly lethal neoplasm. Diagnosis is a difficult problem and most of the cases reported in the literature were diagnosed at postmortem. We report a caseof primary malignant mesothelioma of the pericardium in a 22 year-old man. CT and MR imaging both showed diffuse irregular pericardial thickening, soft tissue density with cystic lesion, nodular bulging into the myocardium, permeative growth of the tumor, and encasement of the heart and two great vessels.