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Case Reports
. 2025 Aug 27;17(8):e91081.
doi: 10.7759/cureus.91081. eCollection 2025 Aug.

Idiopathic Effusive Constrictive Pericarditis in a Young Patient: Early Diagnosis and Curative Surgical Treatment

Alina Mariana Paraschiv  1 , Despina M Toader  2 , Cristina Florescu  3 , Diana Rodica Tudorascu  4 , Tudor Adrian Balseanu  5
Affiliations
Case Reports

Idiopathic Effusive Constrictive Pericarditis in a Young Patient: Early Diagnosis and Curative Surgical Treatment

Alina Mariana Paraschiv et al. Cureus. .

Abstract

We will present the case of a young man with a respiratory condition lasting for several months, treated with anti-inflammatory drugs and antibiotics, who, following an abdominal ultrasound that revealed pericardial fluid, was referred to the Emergency Department of Filantropy Hospital. Serological tests and imaging investigations were performed to establish the diagnosis and etiology. The first imaging impact was the echocardiogram, which revealed suggestive features of constrictive pericarditis, later confirmed through cardiac magnetic resonance imaging. Due to advanced symptoms, right heart failure phenomena, with hepatomegaly and grade 3 Lewis jugular vein distension, the initial treatment was with intravenous loop diuretics at a low dose and a sodium-glucose cotransporter-2 (SGLT2) inhibitor, but with poor tolerance due to a drop in blood pressure. For this reason, the patient was urgently referred to the Cardiovascular Surgery Department, where the case was resolved through pericardiectomy. The histopathological examination did not reveal a specific etiology as the cause of the constrictive pericarditis. The patient's postoperative evolution and paraclinical investigations showed a favorable status. Timely surgical intervention for this patient made the difference between symptom worsening and the potential onset of complications, and the successful resolution of the case.

Keywords: constrictive pericarditis; echocardiography; idiopathic; pericardiectomy; treatment.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Chest X-ray
The chest-pleuro-mediastinal-cardiopulmonary radiograph upon emergency presentation.
Figure 2
Figure 2. Electrocardiogram
The Electrocardiogram (ECG) showed sinus rhythm, heart rate 93 bpm, PR = 120 ms, low-voltage complexes in the limb leads, and a negative T wave in leads II, III, and augmented vector foot (aVF).
Figure 3
Figure 3. Echocardiography
Pulsed Doppler transmitral shows an E wave velocity of approximately 1.5 m/s, with a deceleration time of the E wave of 118 ms, this respiratory variation is a characteristic sign of constrictive pericarditis
Figure 4
Figure 4. Echocardiography
Pulsed Doppler at the level of the tricuspid valve with respiratory variations. This pattern of respiratory variation is frequently associated with constrictive pericarditis.
Figure 5
Figure 5. Echocardiography
The subcostal view at the level of the hepatic veins shows respiratory variations
Figure 6
Figure 6. Echocardiography
In the subcostal view, in M-mode, the enlarged inferior vena cava without inspiratory collapse is highlighted
Figure 7
Figure 7. Chest CT scan (axial)
The image shows pericardial fluid with a maximum size of 3.04 cm.
Figure 8
Figure 8. Cardiac MRI
Cardiac MRI confirms the diagnosis of effusive constrictive pericarditis
Figure 9
Figure 9. Intraoperative image
See this image and copyright information in PMC

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