Chronic constrictive pericarditis.

Hossein Doustkami,Zahra Tavosi,Afshin Hooshyar,Iraj Feizi,Nasrollah Maleki

doi:10.1155/2013/957497

Abstract

Constrictive pericarditis (CP) is a rare clinical entity that can pose diagnostic problems. The diagnosis of CP requires a high degree of clinical suspicion. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. We present a patient with unexplained dyspnea, recurrent right-side pleural effusion, and ascites. Analysis of the ascitic fluid revealed a high protein content and an elevated serum-ascites gradient. Echocardiography, computed tomography, and cardiac catheterization revealed the diagnosis of CP. He underwent complete pericardiectomy and to date has made a good recovery. The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. This case exemplifies the difficulty in diagnosing this condition, as well as the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment.

Highlights

Constrictive pericarditis (CP) is a disease characterized by the encasement of the heart by a rigid nonpliable pericardium due to dense fibrosis and adhesions
Elevated jugular venous pressure can be challenging to detect, even when the assessment is made by experienced clinicians
The overall correlation between clinical assessment of the jugular venous pressure direct measurement of central venous pressure by central venous catheterization is poor; an overall accuracy of 56% has been reported in classifying the central venous pressure as low, normal, or high, with a sensitivity for detection of a high central venous pressure (>10 cm of water) of less than 60% [17,18,19]

Summary

Case Report Chronic Constrictive Pericarditis

The diagnosis of CP requires a high degree of clinical suspicion. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. Echocardiography, computed tomography, and cardiac catheterization revealed the diagnosis of CP. He underwent complete pericardiectomy and to date has made a good recovery. The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. This case exemplifies the difficulty in diagnosing this condition, as well as the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment

Introduction

Discussion and Conclusion

Findings

LV pressure RV pressure