Pericardial Calcification

Excerpt

The normal pericardium is 1 to 2 mm thick. It is comprised of an outer fibrous layer and an inner serous layer, which further subdivides into a visceral layer, or epicardium, and a parietal layer. A potential space that contains approximately 15 to 35 mL of lubrication fluid separates the visceral and parietal layers. The pericardium is a rigid, avascular, fibrous sac, and its primary functions include minor anchoring, lubrication, preventing distension of cardiac chambers, and optimizing diastolic filling. Typically, the pericardium lacks any calcium deposits, and calcification may be a sign of underlying inflammation or a more sinister etiology. Pericardial calcification is a radiological finding most often identified during chest computed tomography (CT) scans.

Often, pericardial calcification is an incidental finding noted during chest or cardiac CT and, as such, remains asymptomatic. However, signs and symptoms associated with pericardial calcification usually develop secondary to constrictive physiology caused by the rigid pericardium. However, a significant point to keep in mind is that pericardial calcification may not be present in up to 20% of constrictive pericarditis cases, and it may be present in the absence of constrictive physiology. Interestingly, recent reports indicate the development of constrictive pericarditis after cardiac transplantation, an unusual presentation, as the transplanted heart is believed to be free of any pericardial tissue.