Effusive-constrictive pericarditis in the absence of overt pericardial disease on multiple imaging modalities

Abstract

Effusive-constrictive pericarditis (ECP) is a rare condition that may prove fatal without appropriate treatment. In ECP, there is concomitant existence of a pericardial effusion and CP, that together lead to impaired cardiac filling. Therapeutic pericardiocentesis only addresses part of the problem; surgical pericardiectomy may be required to relieve the constrictive element. Imaging in ECP characteristically demonstrates calcification or thickening of the pericardium. The authors describe a case of ECP were a number of imaging modalities (including echocardiography, cardiac magnetic resonance and CT) did not identify overt pericardial disease. The patient underwent surgical pericardiectomy that led to a rapid resolution of symptoms and full recovery. Histopathological analysis of the pericardial biopsy indicated a non-specific pericardial fibrosis, in keeping with the final diagnosis of ECP.

Figure 1

Image from CT pulmonary angiogram showing a pericardial effusion, absence of thickening/calcification of the pericardium and bilateral pleural effusions.

Figure 2

Simultaneous right atrial and left ventricular pressure tracings demonstrating equalisation of the pressure tracings during diastole and the ‘square root’ or ‘dip and plateau’ sign.

Figure 3

Cardiac MRI showing the residual pericardial effusion, normal chamber size and absence of thickening/calcification of the pericardium.