A rare case of effusive constrictive cholesterol pericarditis: a case report and review

Abstract

Effusive constrictive cholesterol pericarditis is exceedingly rare. Most cases have an unclear etiology but can be associated with rheumatoid arthritis, tuberculosis infection, and hypothyroidism. The hallmark of the effusion is the distinctively high levels of cholesterol. We present the case of a 68-year-old male with prolonged symptoms of dyspnea with associated moderate pericardial effusion that were later determined to be constrictive effusive etiology, and the patient was referred for stripping with pathologic cholesterol crystal formation on pathology review.

Figure 1

Axial noncontrast CT image of the thorax showing the heart with pericardial effusion.

Figure 2

Hemodynamics noted during the right heart catheterization. (a) Elevated right atrial (RA) pressure showing respiratory variations. (b) Elevated RA pressure despite decreased pericardial space (PS) pressure immediately after evacuation of pericardial fluid. (c) Elevated RA pressure despite full evacuation of fluid.

Figure 3

Hemodynamics during right heart catheterization showing persistence ventricular interdependence between the left ventricle (LV) and the right ventricle (RV) after evacuation of pericardial fluid.