A patient with a history of lupus and recurrent pericarditis presented with signs of constrictive physiology. For pericardial characterization, cardiac magnetic resonance imaging (CMR) was performed. The steady-state free precession (SSFP) cine imaging sequence of CMR is shown in the video, which demonstrates the abrupt displacement of the interventricular septum in early diastole during each cardiac cycle, which is called septal bounce or septal shudder. This is seen in constriction because of ventricular interdependence. The early diastolic filling of the right ventricle leads to the leftward deviation of the interventricular septum followed by a bounce back towards the right ventricle in late diastole. This results from increases in early diastolic pressure in the right ventricle thatexceeds left ventricular diastolic pressures during the cardiac cycle. This is different from the respirophasic shift of the septum, which changes with inspiration. These findings can be associated with acute or recurrent pericarditis causing pericardial inflammation and increased pericardial thickness, which can lead to such imaging findings without true heart failure. The video also shows right-sided pleural effusion secondary to pleuritis from lupus. The likely etiology of constrictive physiology in this patient is the recurrent episodes of pericarditis, eventually leading to a scarred and inflamed pericardium.
Click the Related Article link for a review of CMR findings of constrictive physiology and the Related Video links to watch multimodality imaging findings of constrictive physiology.
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