title: Hyperenhancement of the Pericardium on Cardiac Magnetic Resonance Imaging: A Marker of Acute Inflammation and Neovascularization or a Chronic Fibrotic State.
abstract: In cardiac magnetic resonance imaging, hyperenhancement of the pericardium post gadolinium administration in acute chest pain often signifies pericarditis with an acute inflammatory response and neovascularization. In the context of constrictive pericarditis, case series have indicated that the intensity of hyperenhancement and the thickness of the pericardium imply reversibility of the physiology of the constrictive pericarditis. We present a case of intense hyperenhancement and marked thickening of the pericardium in a patient with constrictive pericarditis with antecedent chest pain. Surgical resection of the pericardium and microscopy revealed a chronic fibrotic state with no evidence of inflammation or neovascularization, thus clarifying the failure of initial medical/anti-inflammatory treatment. Our case highlights the fact that hyperenhancement of the pericardium post gadolinium is non-specific for histology and does not necessarily imply the reversibility of pericardial constriction.
authors.affiliation: University Hospital Aintree NHS Foundation Trust, Liverpool, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Mullen
authors.forename: Pei Gee
authors.initials: PG
authors.lastname: Chew
authors.forename: Frederick
authors.initials: F
authors.lastname: Frost
authors.forename: Ayesha
authors.initials: A
authors.lastname: Ahmed
authors.forename: Aleem
authors.initials: A
authors.lastname: Khand
mesh_terms: D000328:Adult; D005355:Fibrosis; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009389:Neovascularization, Pathologic; D010493:Pericarditis / Q000175:diagnosis*; D010496:Pericardium / Q000473:pathology*; D012008:Recurrence