Pericardial calcification in constrictive pericarditis

Abstract

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.

An Unusual Case of Cirrhosis

“…Pericardial calcification should provide a clue to the diagnosis of constrictive pericarditis (see Figure 1 ). One case study demonstrated the importance of this finding on low-cost imaging to help point towards this diagnosis [ 9 ]. The major differential of constrictive pericarditis is restrictive cardiomyopathy which is more common in patients with sarcoidosis.…”