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Preliminary Diagnosis: Constrictive Pericarditis
I. What imaging technique is first-line for this diagnosis?
Echocardiogram.
II. Describe the advantages and disadvantages of this technique for diagnosing constrictive pericarditis.
Advantages
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Does not require ionizing radiation.
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Inexpensive.
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Allows for dynamic assessment of the heart and the left ventricle.
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Can identify pericardial effusion.
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May be semi-invasive if transesophageal technique is used.
Disadvantages
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May be suboptimal in demonstrating pericardial thickening.
III. What are the contraindications for the first-line imaging technique?
No significant contraindications.
IV. What alternative imaging techniques are available?
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CT.
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MRI.
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Plain radiographs.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing constrictive pericarditis.
CT
Advantages
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Calcification is highly suggestive.
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Pericardial enhancement may indicate an active inflammatory process.
Disadvantages
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Exposure to ionizing radiation.
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No functional evaluation of the heart.
MRI
Advantages
More sensitive in distinguishing pericardial effusion from thickening compared to other imaging modalities.
Disadvantages
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Expensive.
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Time consuming.
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Requires significant patient cooperation to minimize motion artifact.
Plain radiographs
Advantages
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Inexpensive.
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Quick.
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Portable.
Disadvantages
Not specific and not diagnostic without clinical presentation of physiologic constriction.
VI. What are the contraindications for the alternative imaging techniques?
CT
Relative contraindication in pregnancy.
MRI
Absolute contraindication in patients with non-MR compatible hardware.
Plain radiographs
Relative contraindication in pregnancy. Some institutions may require a consent.
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