title: Pericardial disease is often not recognised as a cause of chronic severe ascites.
abstract: OBJECTIVE
  Severe chronic ascites remains a difficult diagnostic and therapeutic problem. Even in the current era, constrictive pericarditis is an underestimated and sometimes unrecognised cause. Moreover, missing the diagnosis deprives patients of remedial therapy.
  
  
  METHODS
  Two cases of calcified constrictive pericarditis, complicated with cirrhosis and diagnosed in a late stage, are described. Due to insufficient clinical appreciation and lack of trust in echocardiography results, performed by cardiologists who were insufficiently familiar with the echocardiographic features of constrictive pericarditis, diagnosis was delayed in the two patients
  
  
  RESULTS
  The diagnosis of constrictive pericarditis as a cause of ascites is based upon the clinical signs of right heart failure in a patient with normal systolic left and right ventricular function and a high, serumascitic albumin-content difference. Complementary workup with complete Doppler echocardiography study, right and left heart catheterisation and MRI or cine CT of the heart is necessary to confirm the diagnosis.
  
  
  CONCLUSIONS
  Careful history taking and clinical examination remain the cornerstone of any diagnostic work-up, even in this era of technological refinement.
authors.affiliation: Department of Hepatology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Van der Merwe
authors.forename: J
authors.initials: J
authors.lastname: Dens
authors.forename: W
authors.initials: W
authors.lastname: Daenen
authors.forename: V
authors.initials: V
authors.lastname: Desmet
authors.forename: J
authors.initials: J
authors.lastname: Fevery
mesh_terms: D000293:Adolescent; D001201:Ascites / Q000175:diagnosis* / Q000209:etiology; D006328:Cardiac Catheterization; D002908:Chronic Disease; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010494:Pericarditis, Constrictive / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed