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====Layers of the Pericardium====
====Layers of the Pericardium====
*The [[pericardium]] is made up of two layers:
*The [[pericardium]] is made up of two layers:<ref =="" “kishore”="">Kishore, K. (2003). The Heart of Structural Development: The Functional Basis of the Location and Morphology of the Human Vascular Pump. J Postgrad Med, 49:282-4.</ref><ref =="" "moore"="">Moore, K. L., Agur, A. M., & Dalley, A. F. (2011). Essential Clinical Anatomy - Fourth Edition. Lippincott Williams & Wilkins.</ref><ref =="" "tank"="">Tank, P. W. (2009). Grant's Dissector - Fourteenth Edition. Lippincott Williams & Wilkins.</ref>
**Fibrous pericardium
**Fibrous pericardium
***Hard protective external layer
***Hard protective external layer
Line 19: Line 19:
****Parietal: reflects onto fibrous pericardium
****Parietal: reflects onto fibrous pericardium
****Visceral: reflects onto [[heart]] and great vessels and forms the epicardium, the external layer of the heart wall
****Visceral: reflects onto [[heart]] and great vessels and forms the epicardium, the external layer of the heart wall
*Pericardial cavity: Potential space between parietal and visceral layers. It contains a serous fluid film that occupies the cavity and functions as lubricant against friction by all chest movements.<ref =="" “kishore”="">Kishore, K. (2003). The Heart of Structural Development: The Functional Basis of the Location and Morphology of the Human Vascular Pump. J Postgrad Med, 49:282-4.</ref><ref =="" "moore"="">Moore, K. L., Agur, A. M., & Dalley, A. F. (2011). Essential Clinical Anatomy - Fourth Edition. Lippincott Williams & Wilkins.</ref><ref =="" "tank"="">Tank, P. W. (2009). Grant's Dissector - Fourteenth Edition. Lippincott Williams & Wilkins.</ref>
*Pericardial cavity: Potential space between parietal and visceral layers. It contains a serous fluid film that occupies the cavity and functions as lubricant against friction by all chest movements.


====Pericardial Sinuses====
====Pericardial Sinuses====

Revision as of 22:00, 9 December 2019

Pericarditis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S., Cafer Zorkun, M.D., Ph.D. [2], Rim Halaby Homa Najafi, M.D.[3]

Overview

Pericarditis is inflammation of the pericardium, which is the double-walled sac that contains the heart and the roots of the great vessels. There can be an accompanying accumulation of fluid that can be either serous (free flowing fluid) or fibrinous (an exudate, which is a thick fluid composed of proteins, fibrin strands, inflammatory cells, cell breakdown products, and sometimes bacteria). Vascular congestion of the pericardium is also present. The underlying myocardium may or may not be inflamed as well. If the myocardium is involved in the inflammatory process, it is called myopericarditis, and CK and troponin levels may be elevated.

Pathophysiology

Anatomy and Physiology of Pericardium

Layers of the Pericardium

  • The pericardium is made up of two layers:[1][2][3]
    • Fibrous pericardium
      • Hard protective external layer
      • Attached to sternum anteriorly by sterno-pericardial ligaments and fused with the central tendon of the diaphragm and great vessels to allow mobility of the pericardial sac against sudden cardiac overfilling
    • Serous pericardium
      • Smooth internal layer made up of 2 components:
        • Parietal: reflects onto fibrous pericardium
        • Visceral: reflects onto heart and great vessels and forms the epicardium, the external layer of the heart wall
  • Pericardial cavity: Potential space between parietal and visceral layers. It contains a serous fluid film that occupies the cavity and functions as lubricant against friction by all chest movements.

Pericardial Sinuses

  • There are two small chambers or sinuses located where the visceral and parietal pericardia are continuous with one another within the pericardial cavity.
  • Transverse sinus:
    • Located posterior to the pulmonary trunk and ascending aorta at the level between the superior vena cava and aortic arch
    • Formed after dorsal mesocardium rupture embryonically
    • Functional role is to allow the unhindered expansion of great arteries posteriorly during cardiac systole
    • Utilized surgically to pass surgical clamps or place ligatures around great arteries.
  • Oblique sinus:

Diseases of the Pericardium

Additional Images

Pathogenesis

  • Bacterial pericarditis results from:
  1. Contiguous spread of infection within the chest,[10][11] either de novo or after surgery or trauma.[12]
  2. Spread from infective endocarditis[13][14]
  3. Hematogenous spread of infection
  4. Direct inoculation as a result of penetrating injury or cardiothoracic surgery
  • Tuberculous pericarditis develops from lymphatic spread of peritracheal, peribronchial or mediastinal lymph nodes or by contiguous spread from a focus of infection in the lung or pleura. There are four pathologic stages observed:[15][16][17]
  • Stage 3: Absorption of effusion with organization of granulomatous caseation and thickening of pericardium secondary to deposition of fibrin and collagen.
  • Stage 4: Development of constrictive pericarditis. The pericardial space is obliterated by dense adhesions with marked thickening of parietal layer and replacement of granulomas by fibrous tissue.
These types of granulomatous pericarditis also occur with fungal infections, rheumatoid arthritis (RA), and sarcoidosis.

Gross Pathology Images

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology









Microscopic Pathology Images

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology



Videos

AKS7kSl4x5k}} Acute Fibrinous Pericarditis

{{#ev:youtube|5fz_W1YxbC8}}

References

  1. Kishore, K. (2003). The Heart of Structural Development: The Functional Basis of the Location and Morphology of the Human Vascular Pump. J Postgrad Med, 49:282-4.
  2. Moore, K. L., Agur, A. M., & Dalley, A. F. (2011). Essential Clinical Anatomy - Fourth Edition. Lippincott Williams & Wilkins.
  3. Tank, P. W. (2009). Grant's Dissector - Fourteenth Edition. Lippincott Williams & Wilkins.
  4. Kishore, K. (2003). The Heart of Structural Development: The Functional Basis of the Location and Morphology of the Human Vascular Pump. J Postgrad Med, 49:282-4.
  5. Moore, K. L., Agur, A. M., & Dalley, A. F. (2011). Essential Clinical Anatomy - Fourth Edition. Lippincott Williams & Wilkins.
  6. Tank, P. W. (2009). Grant's Dissector - Fourteenth Edition. Lippincott Williams & Wilkins.
  7. Ilan Y, Oren R, Ben-Chetrit E (1991). "Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients". Jpn Heart J. 32 (3): 315–21. PMID 1920818.
  8. Shabetai R (1990). "Acute pericarditis". Cardiol Clin. 8 (4): 639–44. PMID 2249218.
  9. Matthews JD, Cameron SJ, George M (1970). "Constrictive pericarditis following Coxsackie virus infection". Thorax. 25 (5): 624–6. PMC 472200. PMID 5489188.
  10. Klacsmann PG, Bulkley BH, Hutchins GM (1977). "The changed spectrum of purulent pericarditis: an 86 year autopsy experience in 200 patients". Am J Med. 63 (5): 666–73. PMID 930941.
  11. Kauffman CA, Watanakunakorn C, Phair JP (1973). "Purulent pneumococcal pericarditis. A continuing problem in the antibiotic era". Am J Med. 54 (6): 743–50. PMID 4200204.
  12. Rubin RH, Moellering RC (1975). "Clinical, microbiologic and therapeutic aspects of purulent pericarditis". Am J Med. 59 (1): 68–78. PMID 1138554.
  13. Ribeiro P, Shapiro L, Nihoyannopoulos P, Gonzalez A, Oakley CM (1985). "Pericarditis in infective endocarditis". Eur Heart J. 6 (11): 975–8. PMID 4076207.
  14. Roberts WC, Buchbinder NA (1972). "Right-sided valvular infective endocarditis. A clinicopathologic study of twelve necropsy patients". Am J Med. 53 (1): 7–19. PMID 4402567.
  15. Peel AA (1948). "TUBERCULOUS PERICARDITIS". Br Heart J. 10 (3): 195–207. PMC 481044. PMID 18610109.
  16. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J (1985). "Primary acute pericardial disease: a prospective series of 231 consecutive patients". Am J Cardiol. 56 (10): 623–30. PMID 4050698.
  17. Mayosi BM, Burgess LJ, Doubell AF (2005). "Tuberculous pericarditis". Circulation. 112 (23): 3608–16. doi:10.1161/CIRCULATIONAHA.105.543066. PMID 16330703.

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