A 63-year-old woman with a pericardial effusion, bilateral pleural effusions, and ascites: is the whole greater than the sum of its parts?
A 63-year-old female presented with dyspnea, leg edema, and abdominal distention. Exam revealed blood pressure of 104/58, pulse 108/min, jugular venous pressure of 8 cm, no pulsus paradoxus, a pericardial rub, muffled heart sounds, decreased basilar breath sounds, ascites, and ankle edema. Electrocardiogram showed low voltage. Imaging revealed thickened pericardium and a pericardial effusion. Hemodynamic tracings postpericardiocentesis revealed elevated right-sided pressures. The patient was diagnosed with effusive constrictive pericarditis. The case and review of this condition are described. Patients with a pericardial effusion and symptoms unresponsive to pericardiocentesis or with pericardial thickening should undergo evaluation for effusive-constrictive pericarditis.
Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Dina M
DM
Sparano
Priya
P
Kohli
Martha
M
Gulati
D001201:Ascites / Q000150:complications*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000150:complications; D004487:Edema / Q000150:complications; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications*; D010494:Pericarditis, Constrictive / Q000150:complications* / Q000175:diagnosis*; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology; D035422:Pleural Cavity / Q000000981:diagnostic imaging / Q000473:pathology; D010996:Pleural Effusion / Q000150:complications*; D014057:Tomography, X-Ray Computed / Q000379:methods