The causes of such thickening include fibrosis, calcification, and neoplasms, although it is usually not possible to differentiate the specific cause by echocardiography. Improved resolution by TEE provides a more accurate assessment of pericardial thickness, especially if fluid accumulation is also present. 251 Pericardial Tumors and Cysts Tumor in the pericardium is usually metastatic from the breast or lung, but other types occasionally occur. The clinical findings are typically a sizable pericardial effusion, at times leading to tamponade, but tumor may also present as single or multiple epicardial tumor nodules, as effusive-constrictive pericarditis, or even as constrictive pericarditis. The effects of radiation therapy on the tumor may further affect the pericardium, resulting in inflammation, effusion, or fibrosis.
Pericardial cysts are rare and are usually located at the right costophrenic angle.
They are readily visualized by echocardiography, and their cystic nature can be differentiated from that of a solid mass. In constrictive pericarditis there are such prominent pathological and physiological changes that echocardiographic abnormalities are always present, and in most cases there are multiple abnormalities. However, no single echocardiographic sign is diagnostic of constrictive pericarditis. Some frequently seen findings are pericardial thickening, mild atrial enlargement with a normal-sized left ventricle, dilation of the vena cava, flattening of LV endocardial motion in mid and late diastole, various abnormalities of septal motion, and premature opening of the pulmonary valve. The Doppler findings of respiratory variations in flow velocities across the atrioventricular valves as well as across the LV outflow and pulmonary venous flow are often highly characteristic and provide additional supportive evidence favoring constriction.