Asymmetric focal pericardial thickening causing physiologically significant constrictive pericarditis.
A 34-year-old woman presented with refractory ascites and edema. Echocardiography revealed normal left ventricular function with a restrictive diastolic filling pattern. Tissue Doppler velocities of the mitral annulus were normal. Cardiac magnetic resonance imaging (MRI) revealed a focal region of pericardial thickening anterior to the right ventricle and normal thickness pericardium in the other segments. However, abnormal delayed enhancement MRI (consistent with inflammation) was present in both the thickened and the normal pericardial segments. Invasive hemodynamics confirmed constrictive physiology and the patient underwent successful pericardiectomy. This case highlights the utility of multimodality imaging in the diagnosis of constrictive pericarditis and the underappreciated fact that the pericardium need not be globally thickened to cause hemodynamically significant constrictive physiology.
Division of Cardiology, Department of Medicine, University of California, Irvine, Orange, California 92868, USA.
Nauman
N
Siddiqi
Morton J
MJ
Kern
Pranav M
PM
Patel
D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010492:Pericardiectomy / Q000379:methods; D010494:Pericarditis, Constrictive / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome