title: [Constrictive pericarditis: the story of a constrained heart].
abstract: BACKGROUND
  Symptoms of constrictive pericarditis may be nonspecific, misleading and may delay or lead to an incorrect diagnosis.
  
  
  METHODS
  We present the case of a 28-year-old male who was admitted to the hospital with progressive dyspnea, thoracic pain and a history of 25 kg of weight gain during the last 2 years. He was evaluated at another facility and his clinical presentation led to an erroneous diagnosis of primary hepatic disease (cirrhosis and portal hypertension). Physical examination showed that he was dyspneic, emaciated, had marked distention of his frontal cranial veins, diminished heart sounds, massive ascites and leg edema. Laboratory tests reported abnormal liver function tests and abdominal paracentesis chylous ascites. Electrocardiogram showed sinus rhythm with generalized low voltage and nonspecific repolarization changes. Heart size was normal on chest radiography. Doppler echocardiography reported bilateral atrial dilatation, a thickened pericardium and a short deceleration time of transmitral flow. A thickened and calcified pericardium was seen on CT scan. Pericardiectomy was performed. Spontaneous polyuria was observed during and after surgery with subsequent improvement of ascites and edema. The pericardium was found to be grossly thickened and inflamed.
  
  
  CONCLUSIONS
  Clinician must be aware of the slow and progressive course of right ventricular failure, as well as to recognize constrictive pericarditis as a cause of chronic ascites.The hemodynamic aspects of the disease are of paramount importance for early diagnosis and opportune treatment.
authors.affiliation: Unidad de Cuidados Intensivos y Medicina Crítica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D. F., Mexico. jorgec@prodigy.net.mx
authors.forename: Jorge Alberto
authors.initials: JA
authors.lastname: Castañón-González
authors.forename: Jorge Antonio
authors.initials: JA
authors.lastname: Amézquita-Landeros
authors.forename: Erich Carlos
authors.initials: EC
authors.lastname: Velasco-Ortega
authors.forename: José Luis
authors.initials: JL
authors.lastname: Deseano-Estudillo
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: León-Gutiérrez
mesh_terms: D000328:Adult; D002915:Chylous Ascites / Q000209:etiology; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D004487:Edema / Q000209:etiology; D006333:Heart Failure / Q000209:etiology; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis; D008103:Liver Cirrhosis / Q000175:diagnosis; D008297:Male; D010492:Pericardiectomy; D010494:Pericarditis, Constrictive / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011141:Polyuria / Q000209:etiology; D014171:Transients and Migrants; D015430:Weight Gain