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Chapter 12 Pericardial Diseases

CHAPTER 12 PERICARDIAL DISEASES

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FIGURE 12-3 A: Chest X-ray of congenital absence of the left pericardium, with an “Snoopy Dog” appearance. Because of the absent pericardium, lung tis- sues ( arrow ) are trapped between the descending aorta and pulmonary artery, mimicking the ear of a snoopy dog. B: Parasternal long ( left ) and apical ( right ) views of the heart with congenital absence of the perica- dium. Because of the leftward shift of the heart, the right ventricle ( RV ) is at the center of the apical image rather than the left ventricular ( LV ) apex; this is often confused with RV volume overload. Cardiac catheterization was performed elsewhere to evaluate an atrial septal defect and showed no shunt before this evaluation. LA , left atrium; RA , right atrium (Video 12-1). C: MRI appearance of congenital absence of the pericardium. Most of the left side pericardium is missing (between two arrows ), and the heart is rotated leftward through the pericardial defect.

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PERICARDIAL EFFUSION AND TAMPONADE Accumulation of fluid or blood in the potential pericar- dial space results in a pericardial effusion, detected as an echo-free space. When the effusion exceeds 25 mL, this echo-free space persists throughout the cardiac cycle. A trivial, potentially physiologic pericardial effusion is a posterior echo-free space that is present only during sys- tole. An effusion is deemed small if the pericardial space is less than 1 cm wide in diastole, moderate if 1 to 2 cm,

they can also be found in the left cardiophrenic angle (Fig. 12-5B), hilum, and superior mediastinum. While usually benign and asymptomatic, pericardial cysts may enlarge and cause compression of the heart and adja- cent structures (11). Drainage of cystic fluid is usually not curative since it reaccumulates, and thoracoscopic or surgical removal is necessary when the cyst becomes symptomatic. CT and MRI can verify the diagnosis and help guide intervention if indicated (Fig. 12-5A and B). &RS\ULJKW ‹ 1

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