Constrictive pericarditis

A constrictive pericarditis is a type of pericarditis which leads to diastolic dysfunction and potentially symptoms of right heart failure. 

Epidemiology

No single demographic is affected as there are numerous causes of constrictive pericarditis. Causes include :

• infection
  • tuberculosis : most common cause
  • viral infection(s)
  • pyogenic infection(s)
• rheumatic fever : rare ⁴
• sarcoidosis
• previous cardiac surgery
• radiotherapy
• chronic renal failure
• idiopathic

Clinical presentation

Clinical presentation is dominated by restricted diastolic ventricular filling resulting in an increase in diastolic pressure in all four cardiac chambers. Patients typically present with symptoms of both left and right sided heart failure including:

• dyspnoea
• orthopnoea
• easy fatigability
• hepatomegaly
• ascites

Pathology

Characterized by fibrous or calcific constrictive thickening of the pericardium, which prevents normal diastolic filling of the heart. It may follow any type of pericardial effusion and may develop within a variable time frame ranging from two or three months to a number of years.

Radiographic features

Plain film / chest radiograph

In approximately 50% of cases there is visible pericardial calcification on CXRs. 

Cardiac MRI

• the pericardium is often thickened to more than 4 mm
• may show septal flattening on cine MRI

Treatment and prognosis

It is potentially curable by a pericardiectomy.

Differential diagnosis

Clinically, it is difficult to differentiate between constrictive pericarditis and restrictive cardiomyopathy. It is important to distinguish between constrictive pericarditis and restrictive cardiomyopathy as the former benefit from pericardial stripping.