Constrictive pericarditis with extensive pericardial calcification: case report and review of literature

Constrictive pericarditis refers to inflammation of the pericardial sac, possibly leading to acute heart failure. More than 80% cases are presumed to be due to recent or remote viral illnesses. Prominent features include chest pain, dyspnea and electrocardiogram (ECG) revealing P-R segment depression, diffuse concave ST segment elevation, and T-wave inversion. Echocardiogram and cardiac magnetic resonance imaging (MRI) can help establish diagnosis. Over time, the pericardium can undergo fibrosis or calcification resulting in excessive symptoms. After medical management with ibuprofen, colchicine or steroids, partial or complete pericardiectomy is considered. We are presenting a case with constrictive pericarditis due to extensive pericardial calcification, and ultimate resolution with pericardiectomy.

Pericardial calcification with plain radiographic features of tuberculosis in a child: incidental finding and a case report

Tuberculous pericarditis is frequently reported as the primary cause of pericardial calcification and occurs in about 1-2% of individuals with pulmonary tuberculosis, this however is a rare finding in the Western world. This is a 12-year-old male child that was referred from a peripheral health care center for plain radiograph of the chest on account of cough, easy fatiguability, night sweats, loss of weight, loss of appetite and dyspnea most times on excersion for more than a month duration. The plain chest radiograph demonstrated normal cardiac size with a cardiothoracic ratio of about 55/120, there is circumferential radio-opacity of calcic density around the peripheral walls of the heart; the pericardial calcification. The vascular pedicle appears slightly widened. The lung fields show extensive streaky opacities with cystic lung changes bilaterally more marked on the left lung field where consolidation, loss of lung volume and pleural effusion are also demonstrated. A two-dimensional echocardiography showed mild-moderate pericardial effusion, thickening of both visceral and parietal pericardium, and echogenic fond-like structures protruding in to the pericardial cavity. A diagnosis of pulmonary tuberculosis with features of tuberculous pericarditis in a 12-year-old male child was established. The patient has been placed on anti-tuberculous drugs, hematinic, and parents advised on good and adequate diet with adequate rehydration and strict drug compliance. Screening of the siblings and members of the family with close contact have also been emphasized. We report the radiographic features of pulmonary tuberculosis and pericardial calcification in a 12-year-old male child due to its peculiar presentation.

P1725 An easily dismissed suspect

Funding Acknowledgements None Introduction Constrictive pericarditis (CP) is a rare etiology of heart failure. Is a chronic inflammatory process, characterized by scarring, fibrosis and pericardial calcification. Several etiologies can be associated with CP, namely infectious, idiopathy and post-surgical. In some cases, CP can extend to the myocardium and/or lead to cardiac dysfunction. Case Report 58 years old woman, active smoking, referred to the emergency room for tachycardia on a routine electrocardiogram. History of 5 months of fatigue and dyspnea to ordinary activities, with progressive aggravation in the last month, associated with weight loss and episodic palpitations. Upon the physical examination presented jugular vein engorgement and peripheral edema. Admission electrocardiogram with atrial flutter at 150 of ventricular frequencies, without other findings. Thoracic radiography without variation (tenues pericardium enhancement), abdominal echography with moderate ascites. Blood work showed elevated liver enzymes, BNP of 230pg/ml, exclusion of infectious tuberculosis and autoimmune panel with isolated positive rheumatoid factor. Transthoracic echocardiography (TTE) at the emergency room show a non-dilated and global left ventricle hypokinesia, with reduced left ventricular ejection fraction (LVEF) and dilatation of the mitral valve ring in the genesis of moderate mitral regurgitation. Anticongestive and antiarrhythmic therapy started with rhythm conversion and clinical improve. Thoracic computed tomography scan reveals an extensive pericardial calcification. 2 months later TTE reveal a preserved LVEF, pericardial calcification, moderate mitral regurgitation, grade III diastolic dysfunction, respiration-related ventricular septal shift, increased of the mitral E-wave velocity with an E/A of 2.76, the peak mitral E-wave decreases 36% with the inspiration, dilated inferior vena cava without respiratory variation. Cardiac magnetic resonance imaging exposes a septal bounce and pericardial calcification, suggestive signs of constrictive pericarditis. The patient waits for cardiac catheterization for confirmation, being with anticoagulation, ACE inhibitors, beta-blockers and mineralocorticoid receptor antagonist medication, remaining in NYHA class I. Discussion Clinical suspicion of CP is key for its identification, since there is not a specific clinical manifestation and generally patients presented heart failure symptoms. Echocardiography is best tool for a clinical physician evaluate heart failure etiologies, and can be used with higher sensitivity and specificity associated to the correct criteria to the diagnosis of CP. Pericardiectomy is the standard treatment, however the moment of its performance is not well established, since patients can remain in NYHA class I several years and the surgical procedure have higher mortality rates.