Asymmetric focal pericardial thickening causing physiologically significant constrictive pericarditis

• Published in: Catheterization and cardiovascular interventions Vol. 79; no. 5; pp. 809 - 811
• Main Authors: Siddiqi, Nauman, Kern, Morton J., Patel, Pranav M.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2012
• Subjects: Adult; Cardiac Catheterization - methods; constriction; Female; Follow-Up Studies; heart failure; Hemodynamics - physiology; Humans; Magnetic Resonance Imaging - methods; Pericardiectomy - methods; Pericarditis, Constrictive - diagnosis; Pericarditis, Constrictive - etiology; Pericarditis, Constrictive - surgery; pericardium; Pericardium - diagnostic imaging; Pericardium - pathology; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed - methods; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.23079

A 34‐year‐old woman presented with refractory ascites and edema. Echocardiography revealed normal left ventricular function with a restrictive diastolic filling pattern. Tissue Doppler velocities of the mitral annulus were normal. Cardiac magnetic resonance imaging (MRI) revealed a focal region of pericardial thickening anterior to the right ventricle and normal thickness pericardium in the other segments. However, abnormal delayed enhancement MRI (consistent with inflammation) was present in both the thickened and the normal pericardial segments. Invasive hemodynamics confirmed constrictive physiology and the patient underwent successful pericardiectomy. This case highlights the utility of multimodality imaging in the diagnosis of constrictive pericarditis and the underappreciated fact that the pericardium need not be globally thickened to cause hemodynamically significant constrictive physiology.© 2012 Wiley Periodicals, Inc.