Clinical Image
Austin J Clin Cardiolog. 2015; 2(1): 1037.
Constrictive Pericarditis: Extensive Pericardial Calcification
Kaplinsky E¹*, Masmitja S¹ and Mulattieri D²
¹Cardiology Unit, Medicine Department, Hospital Municipal de Badalona, Spain
²Diagnostic Imaging Service, Hospital Municipal de Badalona, Spain
*Corresponding author: Dragoni Edgardo Kaplinsky, Cardiology Unit, Hospital Municipal de Badalona, Via Augusta Avenue 9-13 (08911), Badalona, Spain
Received: March 23, 2015; Accepted: September 10, 2015; Published: September 30, 2015
Clinical Image
A 67-year old woman was hospitalized due to a heart failure onset; previous main medical history consisted of osteoporosis and a permanent atrial fibrillation.
Chest x-ray showed an extended pericardial calcification so the initial diagnosis was Constrictive Pericarditis (CP). Transthoracic echocardiography revealed biatral enlargement, an early diastolic septal bounce (most specific sign of CP) and a diffuse pericardial thickening. It was estimated in 5 mm affecting extensively both ventricles (magnetic resonance) but without doubt, best images were achieved by computed tomography (Figure 1:A,B). Patient was discharged receiving furosemide, spironolactone, diltiazem, and acenocoumarol (October 2013). Cardiac catheterization was unnecessary and follow-up remains uneventful.
Figure 1: Extensive calcification of the pericardium showed by computed
tomography: axial (A) And coronal (B) Views.
CP patients often present symptoms of fluid overload and reduced cardiac output in response to exertion [1]. The majority of cases are idiopathic; other causes are tuberculosis, post-cardiac surgery or post-chest radiation [1]. Echocardiography, magnetic resonance and computed tomography can be used to demonstrate pericardial thickness [2].
This last method was considered better than magnetic resonance defining the heterogeneous degree of pericardial thickening or calcification [3].
References
- 1. Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation. 1999; 100: 1380-1386.
- 2. Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013; 26: 965-1012.
- 3. Reinmüller R, Gürgan M, Erdmann E, Kemkes BM, Kreutzer E, Weinhold C. CT and MR evaluation of pericardial constriction: A new diagnostic and therapeutic concept. J Thorac Imaging. 1993; 8: 108-121.
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