[Constrictive pericarditis--a differential diagnosis in therapy refractory ascites].
METHODS
A 62-year-old woman with refractory ascites and histologically proven liver cirrhosis was admitted for implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS). Another 44-year-old man presented for evaluation of a liver disease of unknown origin with refractory ascites.


METHODS
In both patients abdominal ultrasound showed a dilatation of the inferior caval vein and the liver veins. There was no splenomegaly present. In the side projection of the chest X-ray major calcifications of the pericardium were found pointing to the diagnosis of constrictive pericarditis. Diagnosis was proven by combined left and right heart catheterization demonstrating diastolic dip-plateau-phenomenon. The women was treated successfully by pericardiectomy.


CONCLUSIONS
In patients with refractory ascites, dilated jugular veins and dilated liver veins constrictive pericarditis must be suspected. Pericardial calcifications in chest X-ray often given further evidence for the diagnosis which helps to avoid further evaluation of a primary liver disease. The treatment of choice is early surgical pericardiectomy, whereas shunt procedures are not indicated.
Wettstein
M
M
Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich-Heine-Universität Düsseldorf. wettstein@med.uni-duesseldorf.de
Häussinger
D
D
D000328:Adult; D001201:Ascites / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010494:Pericarditis, Constrictive / Q000175:diagnosis*; D019168:Portasystemic Shunt, Transjugular Intrahepatic