07/08. tbl. 96.árg. 2010

Constrictive pericarditis with severe heart failure – a case report and review of the literature

Trefjagollurshús – sjúkratilfelli með umræðu

Constricitve pericarditis is an uncommon condition, often of unknown etiology but can be caused by infections, such as tuberculosis, inflammation of the pericardium, radiation therapy or asbestos exposure. Constrictive pericarditis is characterized by fibrosis and often severe calcifications of the pericardial sac which eventually restricts normal diastolic filling of the heart. This consequently leads to a combination of left and right heart failure, often with prominent jugular venous distentsion, liver enlargement, peripheral edema and lethargy. Diagnosis can be difficult and is often delayed. Surgery, involving partial removal of the pericardial sac, usually leads to relief of symptoms. Here we report a case from Landspitali together with a review of the literature.


Figure 1.
Pressure curves from simultaneous left and right cardiac cathederization, showing the characteristic square-root sign in diastole.           

Figure 2.
A computed tomography (CT) scan showing calcifications in the pericardium (arrow) and pleura.

Figure 3.
Magnetic resonance imaging (MRI) showing the increased thickenss of the pericardium.

Figure 4 a,b.
(a)  A photograph of the lower extremities taken in February 2008, 4 weeks after admission for massive lower extremity oedema and dyspnea. Odema of lower extremities is still seen, in spite of high dose treatment with intravenous diuretics.
(b)  One year after parital percicardectomy. Oedema of lower extremities has almost disappeared.

Figure 5.
A photograph from the operation, showing the thickened and calcified pericardium under the pincette. 

Figure 6.
Pieces of the resected pericardium. Histological examination revealed unspecific inflammation and calcifications.










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