Constrictive Pericarditis in the Light of Multimodal Cardiac Imaging. A Case Report

Abstract

Heart failure (HF) caused by constrictive pericarditis (CP) is very rare, but has a significant healing potential. In order to diagnose it, an initial high level of suspicion is imperative, given that HF presents in a setting lacking clinical signs capable of pinpointing a specific aetiology. However, current modern imaging techniques permit the accurate construction of a diagnosis for CP, clearing the way for surgical treatment. We are describing the case of a 60-year-old male who was hospitalised to our Cardiology Department due to a history of HF that gradually progressed to the congestion stage over the past six months. The diagnosis of CP was established after the examination of echocardiography and cardiac magnetic resonance imaging results. The patient underwent subtotal pericardectomy, and to this date, he has made a full recovery. The purpose of this case report is to highlight the importance of considering less common causes of HF, in addition to the common ones, in order to devise the most appropriate investigations and expedite surgical correction of this condition.

FIGURE 1.

Parasternal long axis view indicating normal dimensions of the left cavities

FIGURE 2.

Panel A: restrictive pattern of transmitral flow with variations between expiration and inspiration of 38%; panel B: variations of transaortic flow between expiration and inspiration of 34%

FIGURE 3.

Panel A: in TDI application, mitral E’ has normal values and varies with the respiratory cycles; panel B: in TDI application, lateral E’ has normal values and varies with the respiratory cycles, without annulus inversus phenomenon

FIGURE 4.

Pulmonary vein flow: decrease in S and D wave velocities during inspiration and increase of atrial reflux in expiration

FIGURE 5.

Thoracic computed tomography (CT) scan: thickening of pericardium with contrast enhancement; panel A: axial non-contrast thoracic CT; panel B: axial contrast-enhanced thoracic CT reveals the presence of pericardial thickening measuring up to 6.6 mm laterally to the right cavities (red arrow)

FIGURE 6.

Panel A: cardiac magnetic resonance imaging (MRI), 4-chamber view cine 2D showing pericardial thickening up to 5.32 mm along the entire length of the right ventricular free wall (black arrows) and bilateral pleural effusions (black stars); panel B: cardiac MRI, 4-chamber view in T1-weighted showing the absence of myocardial injury