Constrictive pericarditis - a difficult diagnosis

Constrictive pericarditis is an uncommon condition, often of unknown etiology. The diagnosis of constrictive pericarditis can be difficult and is often delayed, because the signs and symptoms of this disease can be falsely attributed to other causes. We report the case of a 62-year-old woman presented with a one year history of progressively worsening dyspnea, peripheral oedema, prominent jugular distension, hepatomegaly, ascites. The patient is known with a history of effusive pericarditis. Blood test showed a normal white cell count, anaemia, raised CRP. Chest X-Ray shows a normal sized heart and without calcification of the pericardium. The echocardiographic exam showed septal bounce-abrupt transient rightward movement, left, right ventricular size decreased-heart tubularin shape, mild atrial enlargement, IVC plethoric and unresponsive to respiration, hepatic veins dilated. Doppler echocardiographic findings were consistent with constrictive pericarditis. Cardiac catheterization showed elevation and equalization of diastolic filling pressures, and dips and plateau configuration of ventricular pressure during diastole (square root sign). Based on these results pericardiectomy was necessary. Constrictive pericarditis was also confirmed at the time of surgery. The pericardium was found with thickening of up to 30 mm in some areas. Histopathological exam showed fibrosis and calcification within the pericardium with no evidence of malignancy or tuberculosis. The patient was discharged 10 days later. At 3 months she had no significant symptoms. Diagnosis of constrictive pericarditis remains challenging. Constrictive pericarditis should be suspected in patients with clinical features of right-sides heart failure. Echocardiography and cardiac catheterisation are important investigation in diagnosis of constrictive pericarditis and avoiding unnecessary treatments.