Epicardial Fat Necrosis Leading to Constrictive Pericarditis

Figures

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  Figure 1. Electrocardiogram at Initial Presentation (Index Admission)

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  Figure 2. Computed Tomography Scan at 6-Week Presentation Demonstrating Thickened Pericardium Epicardial fat herniation through a small pericardial defect with adjacent fat stranding is show. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; SVC = superior vena cava.

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  Figure 3. Chest Computed Tomography Angiography at Initial Presentation Retrospective review identified thickened pericardium and fat stranding. Findings at the initial presentation with significant pericardial fat stranding in the vicinity of pericardial defect and epicardial fat herniation. Please note decrease in the inflammatory changes in the follow-up examination above in Figure 2. Abbreviations as in Figure 2.

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  Figure 4. 3-Dimensional Cinematic Rendering of the Heart at Initial Presentation Abbreviations as in Figure 2.

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  Figure 5. Electrocardiogram at the Time of Computed Tomography Diagnosis, 6 Weeks After Initial Presentation

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  Figure 6. Transthoracic Echocardiography Performed at the 6-Week Presentation LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.

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  Figure 7. Transthoracic Echocardiography Parasternal Short-Axis View Illustrating Septal Bounce

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  Figure 8. Transthoracic Echocardiography Parasternal Short-Axis View Illustrating Septal Bounce, With Respirometer

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  Figure 9. Transthoracic Echocardiography Parasternal Short-Axis View, M-Mode, of Septum With Respirometer

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  Figure 10. TTE Apical 4-Chamber View of MV Inflow With Respirometer (A to D) Images show exaggerated respirophasic variation of mitral valve inflow.

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  Figure 11. TTE Apical 4-Chamber Tissue Dopplers (A and B) Doppler imaging showing lateral annulus is high (19 cm/s). Medial is also high (13 cm/s), but there is no clear annulus reversus. TTE = transthoracic echocardiography.

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  Figure 12. TTE IVC View Showing Some Increased Expiratory End-Diastolic Flow Reversal IVC = inferior vena cava; TTE = transthoracic echocardiography.