Figure 1. Normal pericardium. (a) T1 axial spin echo images show the pericardium as a narrow band of low signal intensity over the free wall of the right heart and the posterior wall of the left ventricle (arrows). (b) The space between the main pulmonary artery and the aorta (the aortopulmonary recess) (open arrow) is in continuity with the transverse sinus. Pericardial fluid may collect in this recess and potentially mimic the appearance of dissection.
Figure 2. Pericardial cyst. Axial T1 spin echo images show the extent of the cyst (arrows), with indentation of the right ventricular free wall and right atrium. The signal intensity is high due to recent haemorrhage into the cyst, which caused the acute presentation. Right ventricular filling was impaired on the cine images.
Figure 3. Pericardial defect. (a) Axial spin echo image shows discontinuation of the pericardium (open arrows) over the left atrium. (b) The coronal spin echo image shows an enlarged left atrial appendage, which has herniated through the defect (arrows).
Figure 4. A 22-year-old female presented with pyrexia and pleuritic chest pain. (a) T1 and (b) T2 weighted axial spin echo images show thickened pericardium (arrows). The T2 signal of the pericardium is high, suggesting active inflammation. The patient also had a pericardial effusion (E). Intermediate signal of this fluid on T1 suggests that it is proteinaceous.
Figure 5. A 36-year-old female with hypothyroidism presented with recurrent pericardial effusion. (a–c) Axial spin echo images show a moderate sized pericardial effusion (*). Note the resulting dilatation of the hepatic vein (a). The true extent of the pericardial reflections are well shown, extending further cephalad on the left than the right. Short axis gradient echo images in diastole (d) and in systole (e) showed no impairment of ventricular filling.
Figure 6. Pericardial haematoma secondary to myocardial rupture in a 60-year-old male with acute myocardial infarction. (a) The T1 axial spin echo image shows complex masses, with flow within and behind the left atrium (LA) and anterior to the right atrium (RA) (asterisks). (b) The posterior wall of the left ventricle shows the site of rupture (arrow).
Figure 7. Organized pericardial haematoma. A 58-year-old man with a history of previous road traffic accident. (a) T1 weighted and (b) T2 weighted axial spin echo images and (c) the short axis spin echo image show a saddle shaped lesion (H) of low signal intensity lifting the whole of the heart away from the diaphragm. LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium.
Figure 8. A 47-year-old male with increasing dyspnoea and pleural effusions. (a) T1 weighted and (b) T2 weighted axial images show diffusely thickened pericardium (arrow) encasing the heart, with very little pericardial fluid. The extent of the pleural effusions is well seen.
Figure 9. This 63-year-old man remained symptomatic after pericardectomy for pericardial constriction of unknown aetiology. T1 weighted axial image shows residual thickened pericardium covering the posterior left ventricle (arrows).
Figure 10. This 53-year-old man had a pericardectomy for pericardial constriction due to tuberculosis 30 years previously but was becoming increasingly breathless, with clinical signs of constriction. T1 axial spin echo images confirm that the anterior aspect of the pericardium has been stripped, but that thickened pericardium remains in the atrioventricular (AV) groove (arrows), with consequent narrowing of the AV ring and dilatation of the right atrium (RA). Note also the residual empyema (*) and consolidation in the left lung.
Figure 11. Direct invasion of the pericardium by primary lung carcinoma in a 70-year-old man. This T1 axial spin echo image shows the primary lung tumour (T) obliterating the pericardium and directly invading the right atrium.
Figure 12. Lipomatous infiltration of the interatrial septum in an asymptomatic 68-year-old female. (a) T1 weighted and (b) T2 weighted axial spin echo images show the lesion (asterisk) with signal intensity similar to that of fat. (c) A fat suppressed inversion recovery sequence demonstrated signal reduction, indicating that there is likely to be a significant adipose content.
Figure 13. Malignant haemangiopericytoma in a 53-year-old female who presented with rapid onset of dyspnoea. The T1 weighted spin echo image shows a mass lesion contiguous with the pericardium (arrows), compressing and distorting the right atrium (RA) and right ventricle (RV).
Figure 14. Paraneoplastic pericardial involvement in a 65-year-old man with primary lung tumour. T1 spin echo axial image shows the primary lesion in the lower lobe of the left lung (T). Marked thickening of the pericardium is seen (arrows). Surgical biopsies of the pericardium were clear of malignant cells.
