Magnetic Resonance Assessment of Pericardial Disease in the Setting of Sudden Onset of Congestive Heart Failure
Heiko Mahrholdt, Stefan Hager and Udo Sechtem
Department of Cardiology, Robert-Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
A 65-year-old woman was referred for work-up of new onset of heart failure. She presented with dyspnoea, peripheral oedema and epigastric discomfort. Transthoracic echocardiography revealed normal LV-function and a cystic abnormality between inferior wall and diaphragm. However, extent and haemodynamic significance of this abnormality could not be assessed by an echocardiogram. Prior to the development of heart failure, the lady had sought medical attention due to re-occurring epigastric discomfort and underwent outpatient upper gastrointestinal endoscopy ruling out ulcers.
Cardiovascular magnetic resonance imaging was performed using a 1.5T Magnetom Sonata (Siemens, Germany). Steady-state free precession (SSFP) cine as well as T1 and T2 weighted spin echo imaging confirmed normal LV-function (EF 61%) and revealed a large pericardial cyst extending 19 cm in coronal, 10 cm in sagittal and 8 cm in anterior-posterior direction (Panel A. [Full motion: http://217.160.89.38/rbk.de/mahrholdt/images/figure1/]). Pericardial cysts are usually benign, containing transudative fluid and therefore have lowest signal-intensity in T1 and highest signal intensity in T2-weighted spin echo images. As shown in Panel A the cyst was compressing the inferior vena cava as well as the right side of the heart causing epigastric discomfort followed by heart failure due to systemic reflow obstruction. After fluoroscopic guided drainage (1700 mL) of the cyst (Panel B [full motion: http://217.160.89.38/rbk.de/mahrholdt/images/figure2/]) the patient recovered from all symptoms within hours.
Figure legend
Panel A: The left side depicts transversal SSFP images form caudal (upper panel) towards cranial (lower panel) whereas the right panel visualises oblique short axis from basal (upper panel) towards apical (bottom panel). The pericardium itself is not thickened (white arrow) but a large pericardial cyst (*) can be identified. The cyst compresses the inferior vena cava as well as the right side of the heart resulting in systemic reflow obstruction (black arrows).
Panel B: SSFP images of the same planes shown in Panel A acquired after drainage of the cyst. As a result of successful drainage only remnants of the cyst are still visible (*). Systemic reflow through the inferior vena cava towards the right side of the heart has normalised (white arrows).
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