Constrictive pericarditis

Case contributed by Naim Qaqish

Presentation

Patient with fluid overload known to have congestive heart failure presenting with dyspnea and lower limbs swelling.

Patient Data

Age: 50 years
Gender: Male

Chest

x_ray

Large pericardial calcifications are seen.

Increased cardiothoracic ratio.

Prominent central vessels.

Right-sided pleural effusion and basal atelectasis are also seen.

Liver

ultrasound

The liver appears normal in size, measures (13.8) cm in MCL, with normal echogenicity, and echotexture. No signs of chronic liver disease. Dilated hepatic veins and IVC suggesting systemic venous congestion. No focal lesion.  

A small amount of ascites noted.

The rest of the examination is normal. (images not included)

Case Discussion

Neither pericardial thickening nor calcification is diagnostic of constrictive pericarditis unless the patient has also symptoms of physiologic constriction/restriction which leads to right-sided heart failure initially and progress afterwards to congestive heart failure.

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