Presentation
Known case of pulmonary tuberculosis in the recent past. Chest pain and breathing difficulty since 4-5 months.
Patient Data
Contrast enhanced CT chest shows thickened pericardium (6-7 mm in thickness) with foci of pericardial calcifications adjacent to both ventricles and inferior wall of right ventricle. Both ventricles have tubular configuration with moderate biatrial dilatation. These features are suggestive of calcific constrictive pericarditis.
Moderate right pleural effusion and mild to moderate left pleural empyema are also seen (split pleura sign on left).
Peripheral fibrotic changes with traction bronchiectasis is noted in left lower lobe basal segments, adjacent to the empyema. Few benign appearing soft tissue density nodules are noted in the periphery of the left upper lobe. Otherwise, both lungs appear normal.
Few prominent mediastinal lymph nodes are noted with faint nodal calcifications.
Tricuspid regurgitation (reflux of contrast into IVC and hepatic veins) is also seen with secondary cardiac cirrhotic changes in the liver.
Overall features are in favor of tubercular etiology for thickened, calcified pericardium.
Case Discussion
70 year old male with past history of pulmonary Koch's came with increasing breathlessness and chest pain. CT chest showed calcified, thickened pericardium with tubular morphology of both ventricles and biatrial dilatation - consistent with calcific constrictive pericarditis.
Secondary changes of constrictive pericarditis were also seen in the form of moderate right pleural effusion and tricuspid regurgitation.
Left pleural empyema and few calcified mediastinal lymph nodes suggest to the possible tubercular etiology for pericarditis.
Cardiac cirrhosis of liver was also seen.
It is important to differentiate constrictive and restrictive cardiomyopathy. CT and MRI are complementary to each other in coming to the conclusion. CT helps in depicting pericardial calcifications.
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