Epicardial Involvement of Constrictive Pericarditis Can Be Detected by Magnetic Resonance Imaging

Figures

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  Figure 1. Cardiac magnetic resonance imaging and histopathologic evaluation of patient 1. (A) Steady-state free precession image acquired in the 4-chamber view demonstrates a large right pleural effusion and a smaller left pleural effusion. The left ventricle lateral wall appears thickened, but the pericardium is not distinguishable from myocardium. (B) T1-weighted dark blood image acquired in the short-axis view highlights 7-mm pericardial thickening (arrows) and bright signal in the epicardial region (arrowheads). (C, D) Inversion recovery delayed enhancement image acquired in 4-chamber and short-axis views demonstrates 9-mm pericardial late gadolinium enhancement that encroaches on the epicardium especially along the inferior-lateral wall of the left ventricle. Delayed enhancement in (D) confirms that the epicardial bright signal observed in (C) is also composed of fibrosis. There is no anterior pericardial thickening or late gadolinium enhancement (∗) where the pericardium was removed at the time of tetralogy repair. (E, F) Epicardial and (G, H) pericardial histopathology sections are shown. (E, G) Hematoxylin and eosin–stained sections at magnification ×400 show acute and chronic…

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  Figure 2. Cardiac magnetic resonance imaging and histopathologic evaluation of patient 2. (A) Steady-state free precession image acquired in the 4-chamber view demonstrates that there is no pericardial fluid and normal left ventricle wall thickening. The left ventricle lateral wall measures up to 7 mm (arrows). There is pericardial fat along the left ventricle apex. (B) T1-weighted dark blood image acquired in the short-axis view demonstrates that there is no definitive pericardial thickening. (C, D) Inversion recovery delayed enhancement image acquired in 4-chamber and short-axis views demonstrates significant pericardial late gadolinium enhancement along the lateral wall of the left ventricle that extends into the epicardium (arrows). The adjacent region of normal (dark) myocardium without late gadolinium enhancement represents the subendocardium and midmyocardium (arrowheads). (E, F) Epicardial and (G, H) pericardial histopathology sections are shown. (E, G) Hematoxylin and eosin–stained sections at magnification ×400 show acute and chronic inflammation composed of neutrophils (arrows) and macrophages (arrowheads). (F, H) Masson trichrome stain shown at magnification ×200 highlights…