1093 Multi-modality imaging of a rare cause of constrictive physiology: pericardial ring

Abstract

Abstract Introduction Proper pathophysiologic diagnosis of constrictive pericarditis (CP) usually mandates utilization of multiple diagnostic tools. We report a rare cause of constrictive pericarditis in a 33-year-old female presenting with painful epigastric pulsations, easy fatigability, and lower limb edema of 6 months duration. The patient had no past history of trauma, cardiac surgery, or tuberculosis. Trans-thoracic echocardiography (figure 1, panels A, parasternal long-axis view, and B, apical 4-chamber view) showed an echogenic band (arrow head) across the left (LV) and right (RV) ventricles, with compressed RV cavity. Septal bounce, with shifting of the inter-ventricular septum towards the LV during deep inspiration, was noted; however, Doppler evaluation of the diastolic function was not conclusive of constriction. Cardiac magnetic resonance (figure 1, panel C) and computed tomography with 3D segmentation, using Materialise Mimics and 3-matic software (figure 1, panel D),showed an 8-mm thick, calcified pericardial ring (arrow head) encircling and indenting both ventricles at mid-cavitary level, resulting in bi-ventricular compression and dumbbell-shaped heart. Both ventricles were of average cavity size, with preserved LV size, systolic function and mildly impaired RV systolic function. Right heart catheterization confirmed the diagnosis of constrictive pericarditis. The patient was referred for surgical pericardiectomy. Conclusion Multi-modality imaging is integral for the diagnosis of CP. Our case represents a rare etiology of constrictive physiology. Abstract 1093 Figure 1