Effusive-constrictive Pericarditis Research Articles

Mycetoma Leading to Effusive Constrictive Pericarditis in an Immunocompetent Individual: A Rare Encounter

Mycetoma Leading to Effusive Constrictive Pericarditis in an Immunocompetent Individual: A Rare Encounter

Effusive Constrictive Pericarditis in the Era of COVID-19

Effusive Constrictive Pericarditis in the Era of COVID-19

Semiquantitative 18F-FDG PET/CT in monitoring glucocorticoid response of immunoglobulin G4-related effusive constrictive pericarditis: a case report

BackgroundImmunoglobulin G4 (IgG4)-related effusive constrictive pericarditis (ECP) is a rare manifestation of IgG4-related disease (IgG4-RD). It can lead to persistent pericardial fibrosis, resulting in cardiac tamponade, diastolic dysfunction, and heart failure. Glucocorticoids are the primary treatment for effectively reducing inflammation and preventing fibrosis. However, guidelines for monitoring treatment response are lacking and tapering glucocorticoid therapy for specific target organs remains a challenge. Recent studies on IgG4-RD have demonstrated that semiquantitative measurements of fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in the main involved organs in positron emission tomography/computed tomography (PET/CT) scanning are correlated to disease activity. We present a case of IgG4-related ECP to demonstrate the usefulness of 18F-FDG PET/CT for diagnosing and treatment follow-up of IgG4-related ECP.Case presentationHerein, a 66-year-old woman diagnosed with IgG4-related ECP presented with breathlessness, leg swelling, rales, and fever. Laboratory tests revealed markedly elevated levels of C-reactive protein, and transthoracic echocardiography revealed constrictive physiology with effusion. High IgG4 levels suggested an immune-related pathogenesis, while viral and malignant causes were excluded. Subsequent pericardial biopsy revealed lymphocyte and plasma cell infiltration in the pericardium, confirming the diagnosis of IgG4-related ECP. 18F-FDG PET/CT revealed increased uptake of 18F-FDG in the pericardium, indicating isolated cardiac involvement of IgG4-RD. Treatment with prednisolone and colchicine led to a rapid improvement in the patient’s condition within a few weeks. Follow-up imaging with 18F-FDG PET/CT after 3 months revealed reduced inflammation and improved constrictive physiology on echocardiography, leading to successful tapering of the prednisolone dose and discontinuation of colchicine.ConclusionThe rarity of IgG4-related ECP and possibility of multiorgan involvement in IgG4-RD necessitates a comprehensive diagnostic approach and personalized management. This case report highlights the usefulness of 18F-FDG PET/CT in the diagnosis and treatment follow-up of isolated pericardial involvement in IgG4-RD.

Not So Transient Effusive-Constrictive Pericarditis

A 63-year-old male patient presented with chest pain and signs of volume overload. His work-up revealed a diagnosis of transient effusive constrictive pericarditis of idiopathic etiology. Despite treatment with optimal medical therapy, he continued to experience persistent symptoms eventually requiring radical pericardiectomy.

Abstract 14911: Effusive Constrictive Pericarditis: A Rare Complication of SARS-CoV-2 Infection

Background: SARS-CoV-2 infection can result in cardiac complications, including myocarditis, left ventricular dysfunction, arrhythmias, and acute myocardial injury. Reports of effusive constrictive pericarditis (CP) are rare, and recommendations on management are limited. Description of Case: A 30-year-old male with recurrent episodes of effusive pericarditis after SARS-CoV-2 infection 11 months prior and anasarca presents with worsening fatigue, dyspnea, and weight gain. His echocardiogram showed pericardial thickening, annulus reversus, and interventricular septal bounce. Computed tomography showed pericardial thickening and a complex pericardial effusion. Right and left heart catheterization revealed elevated filling pressures, equalization of diastolic pressures, and ventricular discordance (Figure 1). Infection, malignancy, and autoimmune etiologies of CP were ruled out. Decision Making: The patient was initiated on anti-inflammatory therapy and aggressively diuresed with no improvement in his symptoms. Given recurrent episodes of pericarditis with constriction, the patient underwent a radical pericardiectomy with posterior pericardial release. The pericardium was 1 cm thick with severe fibrosis. Surgical pathology showed acute and chronic pericarditis with negative testing for Mycobacterium tuberculosis. Conclusion: Idiopathic, post-cardiac surgery and post-mediastinal radiation are the most common causes of CP. Acute pericarditis is a known complication of SARS-CoV-2 infection, but ongoing inflammation leading to CP is rare. CP presents with signs of heart failure and should be considered in patients with persistent symptoms of pericarditis.

The Surgical Management of Pericardial Disease.

Pericardiectomy is performed for a wide variety of pericardial diseases including relapsing pericarditis, effusive-constrictive pericarditis, and chronic constriction. In each of these conditions, we prefer complete pericardiectomy with removal of the anterior and diaphragmatic pericardium. Tricuspid regurgitation (TR) and radiation-induced disease present special challenges. Surgical outcomes depend on the underlying pathology, degree of preoperative disability, and associated cardiac and systemic diseases.

P398 ACUTE PERICARDITIS COMPLICATED BY RAPID DEVELOPMENT OF CONSTRICTION: A CASE REPORT

Abstract A 57–years–old man with no previous cardiovascular history presented with fever, hypotension, dyspnoea at rest and chest pain. The electrocardiogram showed sinus tachycardia, PR–segment depression and diffuse concave–upwards ST–segment elevation. Elevated C–reactive protein and low pro–BNP level were found at lab tests, procalcitonin and troponin were negative. Chest X–ray showed bilateral pleural effusion. Transthoracic echocardiogram (TTE) revealed mild–to–moderate serofibrinous pericardial effusion with initial diastolic collapse of right chambers, suggesting cardiac pre–tamponade. Because of the exiguity of liquid component, pericardiocentesis was not performed, patient was stabilized by fluid–challenge with hypertonic solution. Ibuprofen and colchicine were started. Left thoracentesis was performed removing one liter of fluid overall compatible with transudate. Cytological and microbiological examinations were negative. Despite of initial clinical improvement, the patient showed kidney failure and worsening of lung failure; perianal abscess was detected causing sepsis and requiring surgical drainage and antibiotic therapy with vancomycin and piperacillin/tazobactam. Culture exams were negative. After ibuprofen replacement with indomethacin a repeated TTE showed reduced pericardial effusion, but also respiratory variation in ventricular filling with signs of interventricular dependence. Cardiac magnetic resonance showed thickening and high signal intensity of pericardial layers on T2 weighted imaging and ventricular septal shift on free–breathing cine sequences, suggesting effusive–constrictive pericarditis. Left and right cardiac catheterization demonstrated ventricular “dip and plateau” pattern and ventricular discordance. Considering the lack of clinical improvement on medical therapy, off–bypass pericardiectomy was performed. Incomplete adhesion between the two pericardial layers and thick gelatinous material were found. After surgery patient experienced rapid clinical improvement; cardiac index increased from 1.5 to 3.5 L/min/m2. Effusive–constrictive pericarditis is a rare and dreaded complication of acute pericarditis. Surgery, when appropriated, is crucial for prognosis. In our case initial response to anti–inflammatory therapy with reduced pericardial effusion unmasked constrictive physiology in an effusive–constrictive pericarditis. Clinical management was complicated by sepsis which could have played a role in constriction developing.

Effusive-constrictive pericarditis as first manifestation of late-onset systemic lupus erythematosus: an atypical case with grave prognosis

BackgroundSystemic lupus erythematosus (SLE) is a multisystem autoimmune disease that has a great diversity of clinical presentations and occurs mostly in young women. However, late-onset SLE does exist and seldom presents with an atypical case, including pericardial effusion (PE).Case presentationA 64 years old Asian woman presented with weakness all over the body and slight breathlessness for the past 2 days before the hospital admission. Her initial vital signs are 80/50 mmHg for blood pressure and a respiration rate of 24 breaths/min. Rhonchi were heard on the left lung and pitting edema on both legs. No evidence of any skin rash. Laboratory examination displayed anemia, hematocrit decrement, and azotemia. A 12-lead ECG demonstrated left-axis deviation with low voltage (Fig. 1). Chest X-ray showed left massive pleural effusion (Fig. 2). Transthoracic echocardiography revealed biatrial enlargement, normal EF 60%, diastolic dysfunction grade II, and thickening of the pericardium with mild circumferential PE corresponding with effusive-constrictive pericarditis (Fig. 3). The patient also brought CT angiography and cardiac MRI result, which confirmed pericarditis with PE. Treatment was initiated in ICU with fluid resuscitation of normal saline. The patient’s routine oral treatments, including furosemide, ramipril, colchicine, and bisoprolol, were carried on. An autoimmune workup was performed by a cardiologist and demonstrated an elevation in antinuclear antibody/ANA (IF) of 1:100, which finally unveiled a diagnosis of SLE. Pericardial effusion is one critical condition to consider, despite it being an uncommon presentation in late-onset SLE. Mild pericarditis in an SLE case can be treated with corticosteroid administration. Colchicine also has been found to reduce the risk of pericarditis recurrence. However, an atypical presentation from this case led to a slightly delayed treatment that escalated the morbidity and mortality risk. The patient had a sudden cardiac arrest and passed away 3 days after being treated.Fig. 1Initial electrocardiogram demonstrated left-axis deviation, low voltage QRS complex and T-wave inversion on lead V1–V3Fig. 2Chest radiograph showed left massive pleural effusionFig. 3Transthoracic echocardiogram displayed increased left ventricular filling pressure with diastolic dysfunction grade III, mild circumferential pericardial effusion with adjacent pleural effusionConclusionsAtypical presentation during late-onset SLE, mainly in the form of pericardial effusion even constrictive pericarditis, should be taken into a consideration since they are a scarce feature in SLE patients. Swift recognition and prompt treatment are important for the optimal outcome.

Constrictive pericarditis with massive pericardial effusion.

A 27-year-old man was admitted to our hospital for the investigation of pericardial effusion (PE) and ascites. Despite the accumulation of excessive pericardial fluid, vital signs of cardiac tamponade were not observed. He had no prior medical history except for a blunt chest trauma 10 years earlier. Echocardiography showed a tiny heart in extraordinarily retained massive PE (panel A, Supplementary data online, Video S1). Computed tomography (CT) revealed a distended overfilling pericardial cavity that remarkably compressed his heart and lung (panels B and C). Magnetic resonance imaging showed a thickened pericardium and a respiratory septal bounce phenomenon (see Supplementary data online, Video S2). Heart catheterization followed by a pericardial drainage of gigantic 6500 mL amount of exudative fluid suggested constrictive property of diastolic square root sign in left and right ventricular simultaneous pressure tracings (panel D). He was diagnosed with effusive–constrictive pericarditis. Despite the removal of pericardial fluid and the treatment with anti-inflammatory medications, the underlying pericardial constricted property continued to cause symptoms. He underwent a surgical removal of the thickened pericardium uneventfully (panel E). Further analysis of the volume of the thoracic cavity utilizing a comprehensive 3D-rendered CT revealed a significantly greater pre-operative volume of 9569 mL compared with the post-operative volume of 5903 mL (panel F, Supplementary data online, Video S3). This is the first report to suggest that the compensative and elastic ability of both the thoracic and pericardial cavities plays a role in protecting hemodynamics in effusive–constrictive pericarditis.

PERICARDIECTOMY FOR TUBERCULOUS EFFUSIVE-CONSTRICTIVE PERICARDITIS

Effusive-constrictive pericarditis isan uncommon condition characterizedby concomitant existence of pericardial effusionand constriction caused by the visceral pericardium. Tuberculosis remains the main cause in developing countries.The clinical profile of our case is presented as well as a discussion of the definition, etiologies, indications for surgery and surgical management.

Disseminated tuberculosis with purulent effusive-constrictive pericarditis.

Disseminated tuberculosis with purulent effusive-constrictive pericarditis.

Abstract 15745: Effusive Constrictive Pericarditis After Covid-19 Vaccination

Case Report: A 42-year-old male with no significant past medical history presented to the emergency department (ED) after a three-week history of myalgias, non-productive cough, and progressively worsening dyspnea accompanied by a two-week history of right-sided chest pain that all started four days after receiving his Pfizer COVID-19 booster vaccine. Chest pain was described as constant, non-radiating, and aggravated by positional changes. On ED arrival, the patient was febrile to 102.9°F and tachycardic with initial labs significant for leukocytosis of 13.6 Thou/uL, C-reactive protein at 17.18 mg/dL, troponins negative x2, and a negative COVID-19 NAAT testing. EKG revealed diffuse T wave inversions and chest x-ray was noncontributory. Transthoracic echocardiogram (TTE) obtained showed a small fibrinous circumferential pericardial effusion with no evidence of cardiac tamponade; however, there was an interventricular septal bounce suggestive of effusive-constrictive pericarditis. This diastolic septal bounce was also seen on cardiac magnetic resonance imaging, along with a pericardial enhancement measuring up to 0.2 cm in thickness. With a negative infectious and autoimmune workup, along with low clinical suspicion for tuberculosis or malignancy, the leading differential was the temporal relationship between receiving the Pfizer COVID-19 mRNA booster vaccine and the development of effusive-constrictive pericarditis (ECP). The patient was started on Colchicine 0.6 mg twice daily, Ibuprofen 400 mg three times daily, and subsequently discharged after symptomatic improvement and being afebrile for 72 hours with plans for close cardiology follow-up. Discussion: ECP is a rare syndrome characterized by a concurrent decrease in pericardial compliance with pericardial effusion and is seen in 4.5% to 6.9% of patients who present with pericardial effusions. To date, less than five other case reports internationally have delineated a relationship between COVID-19 mRNA vaccines and the development of ECP, making recognition of this etiology challenging. In patients who have a mixed hemodynamic picture with subacute features of both cardiac tamponade and constrictive pericarditis, clinicians should have a high index of suspicion for ECP.

Effusive-constrictive pericarditis as a complication of long-term treatment with adalimumab

Effusive-constrictive pericarditis as a complication of long-term treatment with adalimumab

Tuberculous pericarditis

Tuberculous (TB) pericarditis, a severe extrapulmonary manifestation of Mycobacterium tuberculosis, is notorious for its challenging presentation. We report a case of effusive-constrictive pericarditis due to tuberculosis infection.

Kaposiform lymphangiomatosis complicated with effusive constrictive pericarditis: a rare systemic malformation involving the heart.

Kaposiform lymphangiomatosis complicated with effusive constrictive pericarditis: a rare systemic malformation involving the heart.

Pericardial Diseases

Diseases of the pericardium represent a wide range of clinical syndromes that vary substantially in severity, from a benign pericardial effusion to fatal constrictive pericarditis or hemopericardium. Acute pericarditis is the most common pericardial disease, with viral and idiopathic as the most frequent etiologies. Typically, acute pericarditis can be managed as an outpatient with dual-agent therapy consisting of aspirin or nonsteroidal anti-inflammatory drug plus colchicine and rarely requires admission. Pericardial effusions are fluid collections in the pericardial cavity. They are a common incidental finding, can be associated with other systemic disease, and at their extreme, cause life-threatening cardiac tamponade. Cardiac tamponade exists on a spectrum with patients who are quasi stable to those where cardiovascular collapse and death are imminent. Cardiac tamponade may be temporized with fluid boluses, but treatment is through pericardiocentesis and occasional surgical intervention. Constrictive pericarditis is progressive process with poor prognosis in which the pericardium becomes rigid and causes diastolic dysfunction, leading to heart failure. Once the diagnosis is made, definitive management is surgical but carries a high operative risk. This review contains 7 highly rendered figures, 5 videos, 3 tables, and 42 references. Key Words: cardiac tamponade, constrictive pericarditis, effusive-constrictive pericarditis, pericardial effusion, pericarditis, pericardiocentesis

Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study

BackgroundPrimary pericardial mesothelioma (PPM) is a rare malignancy with a high prevalence of mortality. The diagnosis is usually challenging using a variety of imaging modalities and invasive procedures and is generally performed at the later stages of the disease or in autopsy. This case study points to an unconventional presentation of PPM and the challenges in diagnosing this rare mortal malignancy.Case presentationThis study presents a 44-year-old woman with no remarkable medical history with an initial diagnosis of effusive constrictive pericarditis at first hospitalization. Imaging evaluations, including transthoracic echocardiography and chest computed tomography scan, demonstrated visible thickened pericardium, pericardial effusion, and mass-like lesions in pericardium and mediastinum. The definite diagnosis of primary pericardial mesothelioma was established after pericardiectomy and histopathology examinations. Chemotherapy with pemetrexed and carboplatin was administrated to the patient, and she has been through four cycles of chemotherapy with no complications to date.ConclusionConstrictive pericarditis is an uncommon presentation of PPM. Due to the high mortality rate and late presentation, difficulties and uncertainties in diagnosis, being aware of this rare malignant entity in different cardiac manifestations, particularly when there is no clear explanation or response to treatment in such conditions, is highly important.

Effusive constrictive pericarditis in systemic sclerosis.

Effusive constrictive pericarditis in systemic sclerosis.

Effusive-Constrictive Pericarditis due to Poorly Differentiated Carcinoma of the Mediastinum

Effusive-Constrictive Pericarditis due to Poorly Differentiated Carcinoma of the Mediastinum

Effusive–constrictive pericarditis secondary to pneumopericardium associated with gastropericardial fistula

A 66‐year‐old man with a history of gastric pull‐up reconstruction for oesophageal cancer was hospitalized because of prolonged chest pain. Chest X‐ray demonstrated pneumopericardium. Computed tomography revealed ulceration and abscess in the gastric conduit adjacent to the heart, suggesting gastropericardial fistula. As the patient did not show tamponade physiology, he was conservatively treated with antibiotics. The pneumopericardium diminished; however, he developed effusive–constrictive pericarditis with overt heart failure symptoms. Because pericardiocentesis failed to relieve the symptoms, pericardiectomy was performed. Intraoperative exploration revealed remarkably thickened pericardium and epicardium constituting multiple layers with purulent effusion. Epicardiectomy as well as pericardiectomy were required to achieve the effective reduction of central venous pressure. Perforation of the gastric conduit into the pericardial cavity was identified and repaired. Histopathology demonstrated thickened pericardium composed of hyalinized stroma, collagenous bundles, and infiltration of inflammatory cells. Streptococcus anginosus and Candida tropicalis were identified by culture of the resected tissue.