Effusive-constrictive pericarditis as the manifestation of an unexpected diagnosis

Abstract

Constrictive pericarditis is a clinical condition characterized by the appearance of signs and symptoms of right heart failure due to loss of pericardial compliance. Cardiac surgery is now one of the most frequent causes in developed countries, while tuberculosis remains the most prevalent cause in developing countries. Malignancy is a rare cause but usually has a poor prognosis. The diagnosis of constrictive pericarditis remains a clinical challenge and requires a combination of noninvasive diagnostic methods (echocardiography, cardiac magnetic resonance and computed tomography); in some cases, cardiac catheterization is needed to confirm the diagnosis. The authors present the case of a 51-year-old man, hospitalized due to cardiac tamponade. Diagnostic investigation was suggestive of tuberculous etiology. Despite directed medical therapy, the patient developed effusive-constrictive physiology. He underwent pericardiectomy and anatomopathologic study suggested a neoplastic etiology. The patient died in the postoperative period from biventricular failure. Pericardite efusiva-constritiva; Insuficiência cardíaca; Ecocardiografia; Pericardite efusiva-constritiva como manifestação de um diagnóstico inesperadoResumo A pericardite constritiva é uma entidade clínica caracterizada pelo aparecimento de sinais e sintomas de insuficiência cardíaca direita, secundários à perda da compliance pericárdica. Atualmente, a cirurgia cardíaca tornou-se numa das etiologias mais frequentes nos países desenvolvidos, mantendo-se a tuberculose como a causa mais prevalente nos países em vias de desenvolvimento. As etiologias neoplásicas são mais raras e habitualmente de pior ଝ Please cite this article as: Marta L, Alves M, Peres M, et al. Pericardite efusiva-constritiva como manifestação de um diagnóstico inesperado. Rev Port Cardiol. 2014. http://dx.69.e2 L. Marta et al. Ressonância magnética cardíaca; Diagnóstico prognóstico. O diagnóstico desta entidade mantém-se um desafio clínico, sendo necessária a integração dos achados dos métodos de diagnóstico não invasivos (ecocardiografia, ressonância magnética e tomografia computorizada) e por vezes o recurso ao cateterismo cardíaco. Os autores apresentam o caso clínico de um homem de 51 anos de idade, internado por tamponamento cardíaco. A investigação etiológica foi sugestiva de etiologia tuberculosa, que apesar da terapêutica médica dirigida, evoluiu para fisiologia efusiva-constritiva. Foi submetido a pericardiectomia e o exame anátomo-patológico sugeriu etiologia neoplásica. O doente veio a falecer no pós-operatório em falência biventricular.

The mystery of a deadly recurrent constrictive pericarditis: TB or not TB?

“…Pericardial involvement due to cancer usually presents as pericardial effusion, mainly secondary to metastases arising from either solid tumors or leukemia. Although our case had a history of cervical cancer, this type of cancer is very uncommon among solid tumours causing metastatic CP while lung and breast cancer are highest on this list [4]. Additionally, she did not have a history of radiotherapy.…”

“…Hemodynamic assessment by cardiac catheterization which can be suggestive by showing equalization of diastolic pressures in four chambers and rapid early diastolic ventricular filling (dipand-plateau pattern) [3,4]. An endomyocardial or pericardial biopsy may be required in rare cases to distinguish a restrictive cardiomyopathy from constrictive pericarditis.…”

“…An endomyocardial or pericardial biopsy may be required in rare cases to distinguish a restrictive cardiomyopathy from constrictive pericarditis. The most common etiologies of constrictive pericarditis include post cardiac surgery, radiotherapy, connective tissue disorders, cancer and infections such as tuberculosis (TB) [1,4]. The condition can also rarely occur idiopathically and also in other rare conditions such as IgG4 disease and Whipple's disease.…”