CT in tuberculous constrictive pericarditis.
Constrictive pericarditis (CP) and restrictive cardiomyopathy have the same pathophysiological disorder (impaired diastolic filling) and a similar presentation. To determine the value of a noninvasive technique, CT, in differentiating between the two, we reviewed the CT scans of 212 patients with clinical signs and symptoms of CP and/or restrictive cardiomyopathy, after 26 cases that did not proceed to surgery were excluded. Computed tomography showed pericardial thickening (greater than 3 mm) in 157 patients with proven tuberculous CP. In two children with proven constriction, the pericardium measured between 2 and 3 mm. We determined that pericardial thickening, in the correct clinical setting, is the only CT sign necessary to diagnose CP. Other CT signs, inferior vena cava dilatation (97%), and deviation of the interventricular septum (15%) were confirmatory. Computed tomography accurately differentiates between CP and restrictive myocardial disease, making more invasive modalities such as cardiac catheterization and endomyocardial biopsy, with few exceptions, unnecessary.
Suchet
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Department of Diagnostic Radiology, Baragwanath Hospital, Johannesburg, South Africa.
Horwitz
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D000293:Adolescent; D000328:Adult; D000368:Aged; D002313:Cardiomyopathy, Restrictive / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010494:Pericarditis, Constrictive / Q000000981:diagnostic imaging* / Q000453:epidemiology; D010495:Pericarditis, Tuberculous / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014057:Tomography, X-Ray Computed