Cardiophrenic Space Research Articles

Chest Wall Mass as the Dominant Presentation of Low-Grade B-Cell Non-Hodgkin's Lymphoma: A Case Report.

Low-grade B cell non-Hodgkin's lymphoma with dominant presentation of chest wall mass is presented in this report. The patient, a 65-year-old woman, presented with pain, rising skin temperature and redness, and swelling on the right lower chest wall. The histopathological examination revealed non-Hodgkin's lymphoma; the staging fluorodeoxyglucose-positron emission tomography/computed tomography demonstrated stage IVE disease, with hypermetabolic active disease in the right anterolateral chest wall in the form of large soft tissue mass and subcutaneous tissue with underlying bony erosion with extension into right anterior cardiophrenic space and superiorly up to right second costosternal region along the right internal mammary vessels. This was along with hypermetabolic active right axillary, right supraclavicular and left inguinal lymphadenopathy, and thickened hypermetabolic posterior right pleura with ametabolic right-sided pleural effusion. Bone marrow biopsy revealed uninvolved bone marrow. On follow-up after eight cycles of R-CHOP chemotherapy, the mass had completely resolved on contrast-enhanced computed tomography.

Mediastinal (Epipericardial) Fat Necrosis: An Overlooked and Little Known Cause of Acute Chest Pain Mimicking Acute Coronary Syndrome

Necrosis of the fat adjacent to the heart, referred to as pericardial fat necrosis, epipericardial fat necrosis, and mediastinal fat necrosis, is a rare, self-limited condition. It presents as a sudden onset of severe chest pain that mimics symptoms of pulmonary embolism and acute coronary syndrome. Computed tomography (CT) findings are quite typical and consist of a round- or oval-shaped mass-like lesion containing soft tissue and fat density components in the cardiophrenic space. Lack of familiarity with this condition has led in the past to surgical interventions to remove the mass-like mediastinal fat necrosis. Until the early 2000s, surgical removal of these lesions was deemed the treatment of choice, to exclude a neoplasm. However, the observation that the CT findings of the paracardiac mass resemble fat necrosis seen in other parts of the body and its involution on follow-up CT has led to the realization that the process is a benign and self-limiting one. A dramatic shift in the paradigm of treatment has ensued and surgical treatment is no longer advocated. Awareness of this condition is, therefore, vital so as to diagnose it accurately and avoid unnecessary future surgical interventions.

Detection of Metastatic Disease in Cardiophrenic Lymph Nodes: FDG PET/CT Versus Contrast-Enhanced CT and Implications for Staging and Treatment of Disease

Objective: To determine whether FDG PET/CT was more sensitive than CT in detecting metastatic disease in the cardiophrenic space and whether the presence of disease in this location would change the staging and clinical management.Materials and Methods: About 1200 PET/CT scans were retrospectively reviewed over 20 months for the presence of FDG-avid cardiophrenic lymph nodes. The SUVmax was used to quantify the metabolic activity in each of the lymph nodes. The radiographic data was used for correlation. A retrospective review of diagnostic CT reports performed within a 1-month period of time of the PET/CT in the same subset of patients determined whether cardiophrenic lymph nodes were mentioned.Results: About 9 (0.8%) of the 1200 studies were found to have FDG-avid cardiophrenic lymph nodes (four males and five females with a mean age of 55 years; range 7–69, median 59). The mean SUVmax was 2.4 (range 1.2–7.9; median 1.9). Only three of the patients were found to have suspicious lymph nodes on CT. The presence of cardiophrenic lymph nodes had the potential to change the staging and/or management in three of the patients.Conclusion: PET/CT is more accurate in the detection of pathologic cardiophrenic lymph nodes than CT, especially when they are subcentimeter in size. When present, staging and/or management was potentially affected in 33%. Therefore, these nodes should be included in the TNM staging classification.

Abnormalities in the Cardiophrenic Space

Various types of lesions may occur in the cardiophrenic space, which is located in the most inferior aspect of the anterior mediastinum and is bordered by the heart, diaphragm, and chest wall. Abnormalities detected at radiography and CT often are due to prominent pericardial fat pads, fat-containing tumors such as lipoma, pericardial cysts, enlarged lymph nodes, diaphragmatic hernias, or anterior mediastinal masses, such as thymoma or lymphoma. Although chest radiography can hint at the correct diagnosis, such as a hernia if gas is visible within intestinal loops or a pericardial cyst if an ovoid structure is sharply demarcated and homogeneous, the imaging characteristics of these lesions often can overlap. Both benign and malignant lesions can have a similar appearance. Thus CT is valuable in the diagnosis and differentiation of cardiophrenic space lesions. This article illustrates and reviews the imaging findings and differential diagnoses of lesions that may occur in the cardiophrenic space.

Abnormalities in the Cardiophrenic Space

Contemporary Diagnostic Radiology: November 15, 2012 - Volume 35 - Issue 23 - p 8 doi: 10.1097/01.CDR.0000422141.32222.98

MRI Findings of Pericardial Fat Necrosis: Case Report

Pericardial fat necrosis is an infrequent cause of acute chest pain and this can mimic acute myocardial infarction and acute pericarditis. We describe here a patient with the magnetic resonance imaging (MRI) findings of pericardial fat necrosis and this was correlated with the computed tomography (CT) findings. The MRI findings may be helpful for distinguishing pericardial fat necrosis from other causes of acute chest pain and from the fat-containing tumors in the cardiophrenic space of the anterior mediastinum.

Enfarte da gordura epipericárdica – A propósito de um caso clínico

Epipericardial fat necrosis is an uncommon benign entity of unknown cause, with only 20 cases reported in the English-language literature. It should be remembered as a possible diagnosis in a person who presents with acute pleuritic chest pain and paracardiac density or pleural effusion on chest radiography (X-ray). The computed tomography (CT) or surgical approach allows the final diagnosis and characterization.The authors describe a case of a 48-year-old woman, admitted to our department because of complaints of fatigue, cough and sudden pleuritic pain on thoracic left side. The chest X-ray showed mild/moderate left pleural effusion and CT scan revealed local slight thickening of pericardium and epipericardial fat, surrounded by thick rim of higher density in the left cardiophrenic space. This made the diagnosis of epipericardial fat necrosis. During hospitalization the patient remained stable and was discharged home with symptomatic relieve therapy.Because of benign, self-limited nature of this entity, only conservative treatment is indicated.Rev Port Pneumol 2010; XVI (3): 507-512

Lesions of the Cardiophrenic Space: Findings at Cross-sectional Imaging

Cross-sectional imaging techniques allow excellent visualization of the cardiophrenic space. Under normal conditions, the cardiophrenic space is occupied by fat, the amount of which is usually increased in overweight individuals. It has been suggested that this fat accumulation correlates with the risk of cardiovascular disease. Several alterations originating above or below the diaphragm can affect the cardiophrenic space. Inflammatory lesions such as pericardial fat necrosis and tumoral masses are sometimes seen. Lymphoma is a major but not exclusive cause of cardiophrenic adenopathy and must be differentiated from lymphatic seeding of supradiaphragmatic and infradiaphragmatic malignancies. In patients with portal hypertension, cardiophrenic space varices are not uncommon. Other masses or pseudomasses occurring in this region include pericardial cysts, mediastinal tumors, and diaphragmatic hernia. Computed tomography and magnetic resonance imaging of the thorax are helpful in characterizing cardiophrenic lesions initially identified at plain radiography. Such characterization helps narrow the differential diagnosis when lesions are detected in this location.

Abnormalities of the diaphragm and adjacent structures: findings on multiplanar spiral CT scans.

Abnormalities of the diaphragm and surrounding tissues have been notoriously difficult to image with conventional axial CT. During the past 10 years, the multiplanar imaging capabilities of MR have been used to clarify the organ of origin of masses near the diaphragm. Spiral CT now offers a similar capability. With spiral CT, the peri-diaphragmatic region can be scanned in a single breath-hold, minimizing motion artifacts and virtually eliminating respiratory mis-registration. Axial images of closely spaced, overlapping sections are reconstructed retrospectively from the volumetric spiral CT projection data set. From these images, one can generate high-detail multiplanar reformations through the diaphragm and adjacent abnormalities. As the CT attenuation values inherent to the chest and abdomen cover a wide range, three-dimensional reformations are not expected to depict this anatomy better than two-dimensional reformations can. This is because three-dimensional images generally render structures at the extremes of CT attenuation, or within a narrow window of CT attenuation values. This pictorial essay illustrates the importance of two-dimensional sagittal and coronal reformations of spiral CT scans in evaluating the peri-diaphragmatic area. With these reformations, peri-diaphragmatic abnormalities seen on axial images are localized to the lung, pleura, pericardium, cardiophrenic space, or intraabdominal viscera.

CLINICAL SIGNIFICANCE OF PLEUROPERICARDIAL CYST

PLEUROPERICARDIAL and pleurocoelomic are synonymous terms applied to a thin-walled cystic structure, typically lying on or near the diaphragm in the right cardiophrenic space. Attempts have been made to classify pleuropericardial cysts with other simple cysts of the pleura; however, their mode of origin and location appear to be specific, and they are, therefore, assigned to a separate category. Pleuropericardial cysts must have a much higher incidence than is evidenced by the infrequency with which they have been reported. Johnson 1 stated that he supposed the reason few reports of these cysts appear in the literature is that they are of so little significance in themselves that surgeons seldom feel them worthy of discussion. So far as the patient is concerned this may be true, but from the viewpoint of the chest physician the establishment of the diagnosis is not always simple, and, until definitely classified, a pleuropericardial cyst can