Pericardial Calcification
Gregory Kicska, MD, PhD
DIFFERENTIAL DIAGNOSIS
Common
Prior Pericarditis
Less Common
Prior Hemopericardium
Rare but Important
Prior Radiation
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Any cause of chronic or prior pericarditis may cause pericardial calcification
Calcification features or distribution limited in identifying etiology, history most helpful
Calcifications adjacent to pericardium are often mistaken for pericardial calcifications, particularly when overlying left ventricle
Constrictive pericarditis: Pericardial calcification with dilated IVC, SVC, atria, tubular ventricles, and hepatic vein contrast reflux
Reporting spatial location of calcifications assist in planning surgical therapy
Helpful Clues for Common Diagnoses
Prior Pericarditis
Although TB is uncommon in developed world, it is a common cause of calcified pericardium in developing world
Characteristically thick, irregular, amorphous calcifications predominantly over anterior and inferior RV
Uremic pericarditis: Eggshell calcification pattern
Idiopathic: Diagnosis of exclusion; often result of undiagnosed viral infection
Helpful Clues for Less Common Diagnoses
Prior Hemopericardium
Most commonly from trauma, malignancy, or surgery
Metastasis
Far more common than primary tumors
Nodular pericardium with coexistent hemopericardium
Lung cancer, breast cancer, and lymphoma account for 75% of cases
Helpful Clues for Rare Diagnoses
Prior Radiation
Acute and chronic forms of radiation pericarditis can lead to calcification
Radiotherapy must exceed 40 Gy, a dose most commonly delivered for Hodgkin disease or lung cancer
Acute pericarditis can occur weeks to months after radiation
Acute pericarditis is generally symptomatic
Chronic pericarditis does not occur before 6 months
More often leads to constrictive physiology but can be asymptomatic
Fibrosis of adjacent mediastinal adipose tissue
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