Open Access

Pericardial calcification in constrictive pericarditis

International Journal of Emergency Medicine20125:37

https://doi.org/10.1186/1865-1380-5-37

Received: 11 July 2012

Accepted: 31 August 2012

Published: 13 October 2012

Abstract

Background

A high index of suspicion is required to make the diagnosis of constrictive pericarditis (CP) in patients presenting with cirrhosis and volume overload, as they can otherwise go misdiagnosed for years.

Methods

Case report.

Findings

A 51 year-old man with a history of presumed alcoholic cirrhosis presented to the emergency department with anasarca. Abdominal ultrasound with Doppler demonstrated a nodular cirrhotic liver, but no evidence of portal hypertension or ascites. The chest x-ray, however, was significant for a right-sided pleural effusion and pericardial calcification, suggestive of (CP). Transthoracic echocardiogram and ECG-gated computerized tomography scan of the chest without IV contrast confirmed the diagnosis. The patient was referred to thoracic surgery for definitive pericardiectomy.

Conclusion

The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. Although a multimodality approach is necessary for the diagnosis of CP, this case highlights the utility of chest x-ray, a relatively non-invasive and inexpensive test, in expediting the diagnosis.

Findings

A 51-year-old man presented to the emergency department with anasarca. The patient had a history of presumed alcoholic cirrhosis 15 years prior, but denied any alcohol use since that time. Physical examination was remarkable for massive anasarca, with edema prominent up to his chest. Laboratory studies revealed new elevated creatinine and hyponatremia. Liver function tests and urinalysis were unremarkable. Abdominal ultrasound with Doppler demonstrated a nodular cirrhotic liver, but no evidence of portal hypertension or ascites. The chest x-ray was significant for a right-sided pleural effusion and pericardial calcification (Figure 1, arrowheads), suggestive of constrictive pericarditis (CP). A transthoracic echocardiogram was performed and showed severe ventricular septal shift to the left with inspiration, as well as marked diastolic ventricular septal bounce. An ECG-gated computerized tomography scan of the chest without IV contrast confirmed extensive pericardial calcification (Figure 2, arrowhead), diagnostic of CP. The patient was referred to thoracic surgery for definitive pericardiectomy. The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process [1]. Although a multimodality approach is necessary for the diagnosis of CP [2], this case highlights the utility of chest x-ray, a relatively non-invasive and inexpensive test, in expediting the diagnosis.
Figure 1

Right-sided pleural effusion and pericardial calcification.

Figure 2

ECG-gated computerized tomography scan of the chest without IV contrast.

Declarations

Authors’ Affiliations

(1)
Department of Neurology, Mayo Clinic
(2)
Division of Internal Medicine, Mayo Clinic

References

  1. Marshall A, Ring N, Lewis T: Constrictive pericarditis: lessons from the past five years’ experience in the South West Cardiothoracic Centre. Clin Med 2006, 6: 592–597.PubMedView ArticleGoogle Scholar
  2. Mastouri R, Sawada SG, Mahenthiran J: Noninvasive imaging techniques of constrictive pericarditis. Expert Rev Cardiovasc Ther 2010, 8: 1335–1347. 10.1586/erc.10.77PubMedView ArticleGoogle Scholar

Copyright

© Toledano and Bhagra; licensee Springer. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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