Imaging of pericardium

Question 1

fibrous sac that surrounds the heart which is composed of 2 layers

Answer 1

pericardium

Question 2

innermost layer pericardium that lines the epicardial surface of the heart

Answer 2

visceral pericardium

Question 3

visceral pericardium is separated from the outermost portion of the myocardium by a

Answer 3

layer of epicardial fat which can vary in thickness

Question 4

the parietal pericardium is composed of how many layers

Answer 4

2 layers

Question 5

secrete a small amount of fluid into the pericardial space to lubricate the cavity and therefore the space normally contains 15 to 35 cc of pericardial fluid

Answer 5

mesothelial cells

Question 6

attached to the mesothelial layer of the parietal pericardium and is composed of various layers of collagen and elastic fibers

Answer 6

fibrous pericardium

Question 7

on ct, the pericardium is best visualized where

Answer 7

anterior to the anterior wall of the RV where it is outlined by both epicardial and mediastinal fat

Question 8

appears as a thin 1-2 mm thick curvilinear band of soft tissue surrounding the heart which extends superior to inferiorly from the great vessels to diaphragmatic surface respectively

Answer 8

pericardium

Question 9

pericardial thickness of greater than ___mm in diameter is considered abnormal

Answer 9

4 mm

Question 10

portion of the visceral pericardium that covers the vessels is arranged in the form of 2 short tubes. one encloses the proximal portions of the ascending aorta and pulmonary trunk and is termed

Answer 10

arterial mesocardium

Question 11

the other portion of the visceral pericardium encloses the SVC, IVC and four pulmonary veins and is termed

Answer 11

venous mesocardium

Question 12

this normal arrangement of the visceral pericardium can lead to outpouchings (recesses) or tunnels (sinuses) which often contain pericardial fluid, even in the absence of a pericardial effusion

Answer 12

arterial and venous mesocardium

Question 13

sinus that is found posterior and superior to the LA. it is contiguous with the subcarinal region and forms a posterior pericardial recess. given its extension into the subcarinal region, it can be mistaken for lymphadenopathy

Answer 13

oblique sinus

Question 14

lies superior to the LA, posterior to the aorta and MPA, but anterior to the oblique sinus. it communicates with several recesses including the right pulmonic, left pulmonic, superior aortic, and inferior aortic recesses

Answer 14

transverse sinus

Question 15

these are usually small in size and form the lateral etens of the transverse sinus

Answer 15

left and right pulmonary recesses

Question 16

3 recesses of the pericardial cavity

Answer 16

postcaval recess, left pulmonary vein recess and right pulmonary vein recess

Question 17

blood supply to pericardium

Answer 17

thoracic aorta and pericardiophrenic arteries

Question 18

venous drainage of pericardium

Answer 18

venae pericardiales which drain to azygos vein, SVC or brachiocephalic veins

Question 19

innervation of pericardium

Answer 19

phrenic nerve although vagal innervation from the esophageal plexus supplies some of the posterior pericardium

Question 20

lymphatic drainage of the pericardium

Answer 20

tracheobronchial nodes and less frequently toward the prepericardial lymphatic vessels and nodes

Question 21

majority of pericardial cysts occur at

Answer 21

cardiophrenic angles, on the right greater than the left

Question 22

true or false: pericardial cysts, similar to other mediastinal cysts can contain proteinaeous material or blood products, but should not contain septations and internal enhancement

Answer 22

true

Question 23

pericardial diverticula often cannot be distinguished from pericardial cysts but can be suspected if there is

Answer 23

direct connection of a cyst-like structure to fluid in the pericardial space

Question 24

absence of the pericardium or pericardial defects are most commonly

Answer 24

post surgical

Question 25

pericardial defects can be partial or complete, and are much more common on what side

Answer 25

left

Question 26

Pericardial defects can be associated with what congenital anomalies

Answer 26

ASD, PDA, bicuspid aortic valve or pulmonary abnormalities

Question 27

Best clue on radiograph is the interposition of lung between the main pulmonary artery and transverse aorta on frontal radiographs in patients with

Answer 27

Complete absence of pericardium or larger partial defects

Question 28

Type of pericardial effusion that are common in processes that lead to an increase in right atrial pressure, such as CHF and pulmonary hypertension

Answer 28

Transudative effusions

Question 29

Suggests the presence of a pericardial effusion and occurs when pericardial fluid is outlined on both sides lower attenuation mediastinal and epicardial fat

Answer 29

Fat pad sign

Question 30

In phase sensitive inversion technique (PSIR), pericardial fluid will appear

Answer 30

Very dark, while epicardial fat will appear bright

Question 31

Occurs when the pressure in the pericardial space exceeds of the right ventricle

Answer 31

Pericardial tamponade

Question 32

Typical findings of tamponade

Answer 32

Moderate to large pericardial collection with compression or flattening of the RA and/or RV free wall

Question 33

Most common cause of tamponade

Answer 33

Effusion

Question 34

Large percentage of patients with pericardial inflammation are from what etiology

Answer 34

Viral

Question 35

Patients with acute pericarditis experience

Answer 35

Sharp chest pain which is usually worse on inspiration and when the patient is supine

Question 36

Thickness of the pericardium in acute pericarditis

Answer 36

4 mm

Question 37

Certain etiologies of pericarditis are more likely to lead to chronic fibrous thickening. These conditions include,

Answer 37

Relapsing episode of pericarditis such as renal diseas and certain collagen vascular diseases such as RA, SLE and scleroderma, radiation, infection (tuberculosis), and pericardial injury due to surgery or trauma

Question 38

Enhancement of fibrous pericarditis can be obtained up to how many minutes

Answer 38

10 minutes

Question 39

Condition in which reduced compliance of the pericardium leads to elevated ventricular diastolic pressures

Answer 39

Constrictive pericarditis

Question 40

This condition is secondary to equalization of pressures in all cardiac chambers because the total cardiac volume is determined by scarred and inelastic pericardium

Answer 40

Constrictive pericarditis

Question 41

Noncompliant space in tamponade and constrictive pericarditis can lead to

Answer 41

Ventricular interdependence, as the increased volume in one ventricle leads to decreased volume in the other ventricle

Question 42

Low cardiac output in constrictive pericarditis particularly affects what side

Answer 42

Right

Question 43

In echocardiography, this condition shows equalization of pressures during diastole and the decrease or reversal of blood flow in the hepatic veins during expiration

Answer 43

Constrictive pericarditis

Question 44

Pericardial calcification may be evident in what type of pericarditis

Answer 44

Constrictive

Question 45

Poor compliance of the pericardium in constrictive pericarditis can change the shape of cardiac chambers as the ventricules may show a

Answer 45

Conical appearance

Question 46

Associated findings in constrictive pericarditis as well as tamponade due to elevated right heart pressures

Answer 46

Dilation of SVC, azygos vein, ascites, pleural effusions and peripheral edema

Question 47

Ventricular interdependence in constrictive pericarditis can lead to a classic ____ due to early increase in RV pressures which leads to paradoxical leftward motion of the septum in early diastolic filling

Answer 47

Septal bounce

Question 48

One of the best methods to make the diagnosis of constrictive pericarditis on MRI is to demonstrate

Answer 48

Respiratory variation of the diastolic bounce using free-breathing, nongated cine MRI sequences

Question 49

On expiratory MRI imaging, this feature can help differentiate CP From restrictive cardiomyopathy

Answer 49

Positive intrathoracic pressure increases pulmonary return resulting in a normal configuration of the septum of septal bowing to the right. This is not seen in restrictive cardiomyopathy

Question 50

in rare instances, a patient may present with both a large pericardial effusion and a stiff, noncompliant pericardium, leading to both tamponade and constrictive physiologies, respectively. this syndrome is referred to as

Answer 50

effusive constrictive pericarditis

Question 51

appears as encapsulated fatty lesion with focal inflammation centered in the juxtapericardial fat

Answer 51

epicardial fat necrosis, also called pericardial fat necrosis

Question 52

50% of primary pericardial neoplasms

Answer 52

pericardial mesothelioma

Question 53

true or false: unlike pleural mesothelioma, the association between asbestos exposure and pericardial mesothelioma is unclear

Answer 53

true

Question 54

demonstrates heterogeneous pericardial effusions and pericardial thickening that early in the disease it may be mistaken for acute or chronic pericarditis

Answer 54

pericardial mesothelioma

Question 55

true or false: pericardial mesothelioma has poor prognosis, with few patients survive longer than 12 months after diagnosis

Answer 55

true

Question 56

common intrapericardial germ cell tumors that occur in children are

Answer 56

benign teratomas

Question 57

malignant pericardial germ cell tumors in children should be considered with a heterogeneous appearance, especially if it is located between the

Answer 57

aortic root and LA

Question 58

if fat is present in an intrapericardial tumor, ____ or ____ should be considered

Answer 58

teratomas or lipoblastomas

Question 59

appears as localized or serpiginous masses primarily of fluid attenuation on CT

Answer 59

lymphangiomas

Question 60

enhancement pattern in pericardial lymphangiomas

Answer 60

no internal enhancement, except for the septations

Question 61

enhancement pattern of pericardial hemangiomas

Answer 61

nodular enhancement with progressive filling over time

Question 62

most common malignancies to involve the pericardium and can occur through direct invasion or metastatic spread

Answer 62

lung cancer, breast cancer, lymphoma, melanoma and renal cell ca