Heart in a shell—a cascade of classical findings: a case report

Abstract

Background Idiopathic chronic constrictive pericarditis is an uncommon yet very important clinical entity as prompt diagnosis and early treatment are affiliated with improved outcomes. We describe an uncommon case of constrictive pericarditis with a series of textbook findings and received successful treatment with surgical pericardiectomy. Case Summary A 58-year-old male presented to the emergency department with exertional dyspnea and anasarca. The past medical history was negative for infections like tuberculosis, viral etc, connective tissue disease, prior cardiac surgery, human immunodeficiency virus or any radiation therapy. The vital signs were within normal limits except mild hypoxia while the physical examination was consistent with congestive heart failure. Further investigations with laboratory testing, imaging with chest Xray, computed tomography, echocardiogram, and invasive study with right heart catheterization were all consistent with idiopathic chronic constrictive pericarditis. The patient underwent successful surgical pericardiectomy with significant improvement in clinical condition. Discussion This case highlights the classical signs and symptoms along with important diagnostic features of constrictive pericarditis. It is uncommon to see all the classical features of constrictive pericarditis in one patient as described in the above case. Familiarity with these findings is crucial to make the diagnosis as early treatment is affiliated with improved outcomes.