Constrictive pericarditis diagnosed following liver transplantation

Abstract

Constrictive pericarditis is frequently diagnosed during evaluation of the patients for hepatosplenomegaly and easily missed if notconsidered in differential diagnosis. Herein, we present a patient diagnosed with constrictive pericarditis during his investigation forimpaired liver functions and right heart failure one year after liver transplantation.A thirteen-year-old boy presented with abdominal distention, dyspnea and fatigue. He had undergone liver transplantation due toliver failure in the previous year, and the symptoms had recurred in the last three months. Physical examination revealed normalheart sounds. Abdominal distention and ascites were present. Cardiothoracic index and pulmonary vascular markings were normalon chest X-ray. Echocardiography showed biatrial dilatation. Thickening of the pericardium with calcifications was demonstrated bythorax computerised tomography. High pulmonary wedge pressure and equalization of end-diastolic pressures were found duringcatheter-angiography. Pericardiectomy was performed, histopathology was compatible with chronic fibrinous pericarditis. Thepatient improved dramatically after surgery, the right heart failure findings resolved, and the liver graft functions turned to be normal.Constrictive pericarditis must be considered in differential diagnosis of hepatosplenomegaly, liver dysfunction and right heart failuresince surgical treatment is possible and lifesaving.