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Pericardial disease is often not recognised as a cause of chronic severe ascites
S Van der Merwe1, J Dens, W Daenen
1Department of Hepatology, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
Constrictive pericarditis is an often overlooked cause of severe ascites. Early diagnosis through careful clinical evaluation is crucial for effective treatment and patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Gastroenterology
Background:
- Severe chronic ascites presents diagnostic challenges, with constrictive pericarditis frequently underestimated.
- Delayed diagnosis of constrictive pericarditis can prevent patients from receiving essential therapeutic interventions.
Observation:
- Two cases of calcified constrictive pericarditis complicated by cirrhosis are presented, diagnosed late.
- Diagnostic delays stemmed from insufficient clinical suspicion and underutilization of echocardiography by unfamiliar clinicians.
Findings:
- Constrictive pericarditis diagnosis involves identifying right heart failure with preserved systolic function and a high serum-ascitic albumin gradient.
- Confirmatory tests include Doppler echocardiography, cardiac catheterization, and cardiac MRI or cine CT.
Implications:
- Emphasizes the critical role of thorough patient history and clinical examination in diagnosing ascites causes.
- Highlights the need for increased physician awareness and echocardiographic proficiency regarding constrictive pericarditis.
Background/Aims:
Severe chronic ascites remains a difficult diagnostic and therapeutic problem. Even in the current era, constrictive pericarditis is an underestimated and sometimes unrecognised cause. Moreover, missing the diagnosis deprives patients of remedial therapy.
Methods:
Two cases of calcified constrictive pericarditis, complicated with cirrhosis and diagnosed in a late stage, are described. Due to insufficient clinical appreciation and lack of trust in echocardiography results, performed by cardiologists who were insufficiently familiar with the echocardiographic features of constrictive pericarditis, diagnosis was delayed in the two patients
Results:
The diagnosis of constrictive pericarditis as a cause of ascites is based upon the clinical signs of right heart failure in a patient with normal systolic left and right ventricular function and a high, serumascitic albumin-content difference. Complementary workup with complete Doppler echocardiography study, right and left heart catheterisation and MRI or cine CT of the heart is necessary to confirm the diagnosis.
Conclusion:
Careful history taking and clinical examination remain the cornerstone of any diagnostic work-up, even in this era of technological refinement.