Chronic Dyspnea, Ascites, and Muffled Heart Sounds

Abstract

History An 18-year-old woman had a history of increasing abdominal enlargement and dyspnea of five years' duration. There was mild cyanosis, distended neck veins, muffled heart sounds, abdominal dullness, and liver enlargement on physical examination. Posteroanterior and lateral chest roentgenograms were taken. Diagnosis Constrictive pericarditis with pericardial calcification. Figure 1 shows moderate cardiac enlargement and a calcified plaque along the left contour just below the pulmonary artery. Figure 2 shows a calcific ring almost completely encircling the heart. The cause of constrictive pericarditis remains in doubt in many patients. 1 In some cases, there is a high percentage of tuberculous origin. In other series, tuberculosis has been an infrequent cause. The disorder may also occur following pyogenic infections, connective tissue and neoplastic disease, trauma, radiation, histoplasmosis, active viral infection, asbestosis, and chronic renal failure with uremia. In nearly 50% of patients with constrictive pericarditis, pericardial calcifications can be demonstrated roentgenographically.