Effusive-constrictive radiation pericarditis: Two cases illustrating value of angiocardiography in diagnosis

Abstract

Two patients who probably had received excessive dosages of irradiation therapy following mastectomy for cancer developed symptoms and clinical signs of effusive-constrictive pericarditis. Both patients were at first suspected of having isolated myocardial disease and were treated for heart failure with digitalis. Angiocardiography, however, demonstrated pericardial effusions, delayed circulation times, venous hypertension and normal-sized cardiovascular structures. These data established the diagnosis of effusive-constrictive pericarditis. The first patient died before pericardiocentesis could be performed. In the second patient, cardiac tamponade was alleviated by making a pericardial-pleural window. Persistence of the tachycardia, weakness and exhaustion, associated with mild aortic and mitral regurgitation, suggests myocardial disease due perhaps to irradiation. In 1 patient angiocardiography also showed severe attenuation of the left pulmonary artery due to left pulmonary fibrosis. At autopsy, radiation pulmonary fibrosis of the left lung (the side of mastectomy) was found. Pericarditis and pericardial effusions are ominous developments following neoplastic disease and are usually due to metastases. Rarely, irradiation pericarditis, which is usually associated with pulmonary fibrosis, may be the cause of pericardial effusion. Because of the danger of cardiac tamponade and heart failure owing to constrictive pericarditis, early diagnosis is important. For this angiocardiography is valuable.