Peter Dědič
The evaluation of pericardial diseases has been radically modified by modern imaging techniques, especially by the development of echocardiography. Echocardiography is readily available and does not involve ionizing radiation. In a patient with suspected pericarditis, echocardiography is still the first line modality to explore the pericardium. However pericarditis is a clinical diagnosis that cannot be made independently by echocardiography. The goal of the echocardiographic examination is to evaluate pericardial effusion, thickening or masses in pericardial cavity. Particularly echocardiography can be helpful in establishing a diagnosis and therapy of pericardial tamponade, but necessary integration with other clinical and hemodynamic data. Echo-guided pericardiocentesis is life saving and safe therapeutic method in a patient with pericardial tamponade. Echocardiographic guidance of pericardiocentesis is technically less demanding and can be performed at the bedside. Transthoracic echocardiography is routinely performed for the evaluation of myocardial function in patients with symptoms of constrictive or restrictive physiologic change; it is not highly accurate in the depiction of pericardial thickening. Respiration-correlated Doppler techniques and tissue Doppler imaging are particularly useful in the differential diagnosis of constrictive pericarditis and restrictive cardiomyopathy. Transesophageal imaging is indicated only for better visualization of the pericardium, pericardial recesses and tumor mass. When transthoracic echocardiographic images are inadequate, especially in nonechogenic and postoperative patients, alternative tomographic imaging procedure may be needed. Computed tomography and magnetic resonance imaging are second-line imaging modalities for diagnosis of pericardial diseases with excellent anatomical and spatial resolution.