Constrictive Pericarditis Presenting as Isolated Ascites

Abstract

Constrictive pericarditis is a rare cause of right-sided heart failure secondary to a stiff, non-compliant pericardium. Clinical presentation can vary considerably and requires a high suspicion for diagnosis. A 31-year-old male presented to the emergency department with complaints of abdominal distension. An abdominal ultrasound revealed large volume ascites; thus, it was initially suspected he had underlying cirrhosis. However, an echocardiogram revealed a diagnosis of constrictive pericarditis. It's important for clinicians to consider constrictive pericarditis in a patient presenting with unexplained right-sided heart failure.

Keywords: Cardiac MRI; Echocardiography; Pericardial Diseases.

Fig. 1

Marked thickening of pericardium (arrow)

Fig. 2

Demonstrating medial E' velocity of 27.4cm/s, exceeding Mayo Clinic criteria of 9.0 cm/s for constrictive pericarditis

Fig. 3

The hepatic venous index of diastolic reversal velocity divided by systolic forward velocity equals 0.82 (NR = 0.78)

Fig. 4

Diffuse, circumfrential pericardial thickening is seen measuring up to 6 mm without pericardial effusion or calcification

Fig. 5

The pericardium was dense and fibrotic completely encapsulating the heart. At the beginning of the procedure, the central venous pressure (CVP) was 25 mmHg. After the pericardium was incised to the level of the pericardial fat and removed the CVP was 15 mmHg

Fig. 6

Histopathologic examination revealed dense pericardial fibrosis with minimal microscopic calcification and epicardial neovascularization consistent with idiopathic constrictive pericarditis