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(Circulation. 1998;97:806.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Constrictive Pericarditis

Steven D. Correa, MD; ; Ezra A. Amsterdam, MD

Correspondence to Ezra A. Amsterdam, MD, Division of Cardiovascular Medicine, University of California, Davis, 4150 V St, Suite 3500, Sacramento, CA 95817.

A 51-year-old man was admitted to an outside hospital for weight gain, dyspnea on exertion, and orthopnea. He was found to have bilateral pleural effusions, ascites, and marked peripheral edema. An echocardiogram revealed normal right and left ventricular systolic function. As a result of the echocardiographic findings, congestive heart failure (CHF) was given a low priority in the differential. Subsequently, an extensive and comprehensive workup was undertaken, including consultations by specialists in infectious disease, rheumatology, oncology, surgical oncology, and pathology. With the goal of discovering an occult malignancy, multiple tissues and fluids were obtained and sent for pathological evaluation. These included pleural and peritoneal fluid, cervical lymph nodes, pleural biopsy, biopsy of a pelvic mass, and bladder biopsy. All biopsies, cultures, and serologies were negative for neoplasia, infection, or vasculitis. The patient was then referred to our institution for further evaluation.

History and physical examination were consistent with the diagnosis of CHF. A Swan-Ganz catheter was placed for bedside hemodynamic monitoring while aggressive diuretic therapy was administered. Simultaneous right and left heart catheterization demonstrated equalization of elevated ventricular diastolic pressures and normal systolic function. The right ventricular pressure tracing was consistent with a constrictive or restrictive process (Fig 1a). Computerized tomography of the chest demonstrated a thickened pericardium, which confirmed the diagnosis of constrictive pericarditis (Fig 2). The patient was referred to cardiothoracic surgery for pericardiectomy.

View larger version (22K): [in this window] [in a new window]   Figure 1. a, Initial bedside right ventricular (RV) pressure tracing with simultaneous electrocardiogram (EKG). Note elevated RV diastolic pressure with characteristic dip-and-plateau . . . [Full Text of this Article]

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				R. B. McCully, S. T. Higano, J. K. Oh, E. A. Amsterdam, and S. D. Correa Diagnosis of Constrictive Pericarditis • Response Circulation, May 11, 1999; 99(18): 2476 - 2479. [Full Text] [PDF]