Imaging pericardial disease.

Pericardial disease has a variety of presentations depending upon whether the pericardium is absent, is thickened from inflammation or tumor, or constrains fluid under pressure, thereby restricting cardiac filling and output. The choice of an imaging modality is influenced by a number of factors: the anticipated presence of calcium, cardiac motion, spatial and contrast resolution required, adequate imaging window into the mediastinum, contrast media requirements, and clinical situation. Although many of the imaging modalities discussed herein have common features, some offer unique attributes, namely motion analysis, fat and water discrimination, and calcium detection. The complexity of many pericardial problems plus the risk of pericardial surgery not uncommonly require a multimodality imaging approach for complete definition.