Constrictive pericarditis: lessons from the past five years’ experience in the South West Cardiothoracic Centre

Marshall, Andrew J.; Ring, N J; Lewis, Terence

doi:10.7861/clinmedicine.6-6-592

Cited by 13 publications

(9 citation statements)

References 6 publications

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“…The patient was referred to thoracic surgery for definitive pericardiectomy. The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process [1]. Although a multimodality approach is necessary for the diagnosis of CP [2], this case highlights the utility of chest x-ray, a relatively non-invasive and inexpensive test, in expediting the diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Pericardial calcification in constrictive pericarditis

Toledano

2012

Int J Emerg Med

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BackgroundA high index of suspicion is required to make the diagnosis of constrictive pericarditis (CP) in patients presenting with cirrhosis and volume overload, as they can otherwise go misdiagnosed for years.MethodsCase report.FindingsA 51 year-old man with a history of presumed alcoholic cirrhosis presented to the emergency department with anasarca. Abdominal ultrasound with Doppler demonstrated a nodular cirrhotic liver, but no evidence of portal hypertension or ascites. The chest x-ray, however, was significant for a right-sided pleural effusion and pericardial calcification, suggestive of (CP). Transthoracic echocardiogram and ECG-gated computerized tomography scan of the chest without IV contrast confirmed the diagnosis. The patient was referred to thoracic surgery for definitive pericardiectomy.ConclusionThe diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. Although a multimodality approach is necessary for the diagnosis of CP, this case highlights the utility of chest x-ray, a relatively non-invasive and inexpensive test, in expediting the diagnosis.

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Section: Resultsmentioning

confidence: 99%

Pericardial calcification in constrictive pericarditis

Toledano

2012

Int J Emerg Med

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“…10 En ellos, puede evidenciarse engrosamiento pericárdico (es patológico un espesor mayor de 2 mm) y calcificaciones pericárdicas. 1,6 Esto último puede observarse también, aunque de manera infrecuente, en la radiografía de tórax. 10 En En la foto, se puede observar el grosor aumentado del pericardio resecado.…”

Section: Discussionunclassified

“…Puede constituir el estadio evolutivo final de procesos inflamatorios que afectan al pericardio, aunque, en un alto porcentaje de casos, no puede identificarse un origen etiológico concreto. 1 La principal causa infecciosa en nuestra población es la tuberculosis. 2 El mayor desafío que presenta es el de realizar un diagnóstico oportuno, ya que suele presentarse de forma oligosintomática y pasar desapercibida hasta llegar a fases avanzadas de la enfermedad.…”

Section: Introductionunclassified

Hepatomegalia como forma de presentación en pericarditis constrictiva. Caso clínico pediátrico

et al. 2019

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Presentación de casos clínicos RESUMENLa pericarditis constrictiva es una entidad poco frecuente en pediatría, en la cual existe una limitación para la diástole cardíaca por fibrosis del pericardio. El origen etiopatogénico de esta patología es múltiple, encontrándose en primer lugar, la pericarditis constrictiva idiopática y, en segundo, la infección por Mycobacterium tuberculosis. El diagnóstico constituye un desafío clínico, ya que requiere de un alto grado de sospecha. Suele presentarse de forma oligosintomática. La presencia de edema, ascitis y alteración de la función hepática suele orientar el estudio hacia una enfermedad hepática primaria. Una cuidadosa historia clínica y examen físico, junto con estudios por imágenes adecuados, constituyen las piedras angulares del diagnóstico. El tratamiento quirúrgico realizado de forma oportuna resulta curativo en la gran mayoría de los pacientes. Se presenta el caso de un paciente de 16 años que inicia estudios por hallazgo de hepatomegalia asociada a disnea grado 1-2 en un control de salud habitual. ABSTRACTConstrictive pericarditis is a rare entity in pediatrics in which there is a limitation for cardiac diastole due to fibrosis of the pericardium. The etiopathogenic origin of this pathology is multiple, finding idiopathic constrictive pericarditis firstly and Mycobacterium tuberculosis infection secondly. Diagnosis is a clinical challenge since it requires a high degree of suspicion. It usually presents as oligosymptomatic or with signs and symptoms of low cardiac output. The presence of edema, ascites and impaired liver function usually guides the study towards primary liver disease. A careful clinical history and physical examination together with adequate imaging studies are the cornerstones of the diagnosis. Surgical treatment is curative in the vast majority of patients. We present the case of a 16-yearold patient with hepatomegaly and dyspnea grade 1-2 found in a routine health check-up. Hepatomegalia como forma de presentación en pericarditis constrictiva. Caso clínico pediátricoHepatomegaly as a form of presentation in constrictive pericarditis. A pediatric clinical case

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“…2 The diagnostic accuracy of conventional flow Doppler is poor in the case of constrictive processes. 4 Tissue Doppler imaging (TDI) is a novel, noninvasive technique for the assessment of cardiac function by myocardial tissue velocity and deformation rather than blood flow. 6 In contrast to flow Doppler, it allows us to distinguish constrictive physiology caused by pericardial pathology from restrictive physiology of diseased myocardium.…”

Section: Commentarymentioning

confidence: 99%

Under Pressure for a Diagnosis

Lunze

Feldman

2010

Clin Pediatr (Phila)

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A 16-year-old adolescent male presented to his primary care physician with a low-grade fever and symptoms consistent with an upper respiratory tract infection. Over the next 3 months, he received 2 courses of azithromycin and albuterol. His cough never resolved, and he developed worsening dyspnea on exertion. He was finally admitted to an outside hospital, where a chest X ray revealed bilateral pleural effusions and an enlarged heart. Pleural and pericardial effusions were confirmed on CT.His dyspnea on exertion and radiological findings prompted the placement of bilateral chest tubes followed by mechanical ventilation for 5 days. After an echocardiogram, a pericardiocentesis without concurrent cardiac catheterization drained 127 mL of fluid. No active bacterial, fungal, or viral infections were found. He was also treated with stress-dose steroids. He was transferred to Johns Hopkins Hospital with massive pleural fluid output of 3 to 5 L per day.His past medical history was significant for ADHD, gastroesophageal reflux disease, milk protein allergy, and allergic colitis as an infant. He had been diagnosed with constitutional growth delay with, his height and weight were below the fifth percentile. His family history and social history were unremarkable.On physical exam, he appeared fatigued and had an increased work of breathing. His respiratory rate was 23 breaths per minute with a room air oxygen saturation of 100%. His heart rate was 125 bpm, with a normal blood pressure. The lower lung breath sounds were decreased bilaterally. Jugular venous distention was not visible. He had a quiet precordium with a normal heart exam but for tachycardia. His abdomen was distended and demonstrated shifting dullness. He had no lower-extremity or sacral edema.Pleural fluid studies revealed a pleural fluid-to-serum LDH (Lactate dehydrogenase) ratio of less than 0.6, fulfilling Light's criteria characteristic of transudate. 1 LDH was 124 U/L, less than two thirds the upper limit of normal. The pleural fluid-to-serum protein level was just greater than 0.5 at the outside hospital but was less than 0.5 at Johns Hopkins. Laboratory studies at the outside hospital and at Johns Hopkins were remarkable for a negative infectious disease workup and no signs of rheumatological disease or oncological disease. His liver function tests were abnormal on admission (Table 1).An ECG, an echocardiogram, a thoracic and abdominal CT, and an abdominal ultrasound revealed a low-voltage QRS, a small pericardial effusion, bilateral areas of consolidation in the left and right lower lobes, large amounts of ascites, and patent hepatic vasculature with normal liver echotexture. A trial of stress-dose steroids did not improve his symptoms as 3 to 5 L/d of pleural fluid continued to drain from his chest tubes daily.A follow-up echocardiogram 1 week later revealed impaired diastolic dysfunction, which led to a right and left heart catheterization with pressures consistent with constrictive pericarditis. A retrospective review of the first echocardiogram sho...

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Constrictive pericarditis: lessons from the past five years’ experience in the South West Cardiothoracic Centre

Cited by 13 publications

References 6 publications

Pericardial calcification in constrictive pericarditis

Pericardial calcification in constrictive pericarditis

Hepatomegalia como forma de presentación en pericarditis constrictiva. Caso clínico pediátrico

Under Pressure for a Diagnosis

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