pericardial calcification

Pericardial calcification is usually seen in individual patients with a history of pericarditis and may be associated with constrictive pericarditis.

Pathology

Although historically infective pericarditis was the most common cause, a wide variety of insults can lead to calcification of the pericardium.

Radiographic features

Pericardial calcification is more common over the right side, anterior and diaphragmatic aspects of the heart in the atrioventricular grooves . Calcifications over the left ventricle or cardiac apex are rare, unless pericardial calcification is extensive. It is important to assess for signs of associated constrictive pericarditis.

Plain radiograph
  • a curvilinear density at the extreme margin of the cardiac silhouette (better on lateral view)
  • extension of calcification over the pulmonary outflow tract (better on lateral view)
  • dilated ​left atrium: due less pericardial investment, even with pericardial constriction, mimicking mitral stenosis

Tuberculous calcifications are the most dense, in the atrioventricular grooves and appear as thick, amorphous oblique circles or arcs of calcifications then spread over the atria and ventricles .

Treatment and prognosis

Medical management is ineffective, and surgical resection of the diseased pericardium is usually performed.

Differential diagnosis

The differential diagnosis for pericardial calcifications include:

  • constrictive pericarditis: in the setting of heart failure with concern for constrictive pericarditis or restrictive cardiomyopathy, calcifications are highly suggestive of the former
  • chronic adhesive pericarditis in the absence of constriction: less dense with a more patchy distribution
  • rheumatic pericarditis 
  • myocardial calcification: more left-sided and localized calcification (e.g. over the cardiac apex from prior infarction