**9.4 Echocardiogram**

While echocardiography is performed to rule out heart failure, left ventricular, right ventricular dysfunction, and valve dysfunction, it is very important to distinguish between constrictive pericarditis and restrictive cardiomyopathy, which is most confused (**Table 3**). In echocardiography performed specifically for constructive pericarditis; movement-shift of the ventricular septum towards the left ventricle, as an indicator of increased vena cava inferior pressure; Enlargement of the hepatic veins and inferior vena cava is seen. Pericardial thickening, calcification is seen.


*Computed Tomography (CT):* Measurement is made for pericardial thickening and calcification in cardiac CT of the heart (**Figure 1**). Pericardial thickening is detected at a rate of 72% and pericardial calcification at a rate of 35% in CT [29]. In addition, defect in the ventricle contour is detected due to pathology-disease in the pericardium in CT [58].


#### **Table 3.**

*Clinical and examination findings in the differential diagnosis of constrictive pericarditis and restrictive cardiomyopathy (\* due to significant x and y descents, \*\*pericardial knock).*

#### **Figure 1.**

*Computed tomography view of calcific pericardium in constrictive pericarditis.*

*Cardiac Magnetic Resonance Imaging (CMRI*): Provides information on cardiac anatomy including pericardial thickness, calcification and pericardial effusion, such as CMRI, cardiac CT [58, 59].

*Chronic Constrictive Pericarditis DOI: http://dx.doi.org/10.5772/intechopen.110136*

*Delayel gadolinium enhancement (DGE):* Granulation tissue and chronic inflammation in the DGE of the pericardium are associated with increased fibroblast proliferation and neovascularization [60]. DGE of the pericardium shows the presence of inflamation, which is a part of the constrictive process, and highlights medical therapy, which is an early -stage option in the treatment [61].

*Invasive Haemodynamics evaluation:* Hemodynamic catheterization is necessary when non-invasive evaluation methods for CP are inadequate. Especially if the central venous pressure is less than the expected value (less than about 15 mmHg), the sensitivity of the evaluation with catheterization is high [62].
