Constrictive pericarditis caused by solitary metastatic carcinosis of the pericardium and complicated by radiation fibrosis of the mediastinum

Abstract

1. 1. A case of chronic constrictive pericarditis produced by diffuse metastatic carcinoma of the pericardium is presented. The pericardial carcinoma was the only metastasis from a primary breast carcinoma completely resected fourteen years previously. 2. 2. The etiology of constrictive pericarditis must include metastatic carcinoma as well ast uberculosis, nonspecific undetermined fibrosis, trauma, and pyogenic inflammation of the pericardium. 3. 3. Radiation contributed to the fibrosis but was not responsible for the constrictive pericarditis. The constrictive encasement of the heart was produced by the scirrhus stromal reaction to the tumor cells. 4. 4. The pulmonary and mediastinal fibrosis secondary to radiation therapy complicated and obscured the diagnosis. 5. 5. Jaundice may occur during the course of constrictive pericarditis and is secondary to chronic congestion of the liver. 6. 6. Electrocardiographic changes of acute pericardial injury (RS-T elevation and T-wave changes) occurring during the course of constrictive pericarditis may indicate either active tuberculosis or the presence of actively growing tumor tissue.