Radiology Teaching Files > Case 52985259

Contributed by: University Hospitals of Geneva, Martins Martina, HUG, Switzerland.
Patient: 55 year old male
History: Patient with a past history of tuberculosis, progressive dyspnea, orthopnea and edema in the lower limbs.

Fig. 1: Thorax frontal

Fig. 2: CT chest
Findings: The chest X-ray shows cardiomegaly, right sub-pulmonary pleural effusion and bilateral bands of consolidation above the diaphragm. The CT image shows extensive calcification of the visceral and parietal pericardium with a loculated pericardial effusion around the left and right ventricles. A bilateral pleural effusion is also present with an underlying right lower lobe consolidation.
Diagnosis: Calcified constrictive pericarditis

Calcified constrictive pericarditis accounts for approximately 1% of the complications of pulmonary tuberculosis.

The pericardial fat surrounding the heart can fill the costodiaphragmatic angles and produce an opaque image on a frontal chest X-ray. The visceral and parietal pericardium cannot be differentiated on a chest X-ray. On CT images, the pericardium is well silhouetted by the pericardial fat against the pericardial surface and the epicardial fat against the myocardial surface. The pericardium is 1 to 2 mm thick. A pericardial effusion can be visible on a lateral chest X-ray, in front of the anterior border of the heart. Pericardial calcifications are often best seen on the lateral view.

References: Trautner BW, Darouiche RO. Tuberculous pericarditis: optimal diagnosis and management. Clin Infect Dis 2001;33:954-61.
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Additional Details:

Case Number: 52985259Last Updated: 2011-06-26
Anatomy: Other   Pathology: Other
Access Level: Readable by all users
Keywords: english, terminée, hug, disim radiologieACR: 5.20

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