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[Constrictive pericarditis--a differential diagnosis in therapy refractory ascites]
1Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich-Heine-Universität Düsseldorf. wettstein@med.uni-duesseldorf.de
Deutsche Medizinische Wochenschrift (1946)
|January 12, 2001
Summary
Constrictive pericarditis can mimic liver disease symptoms like refractory ascites. Suspect this condition with dilated jugular and liver veins, and consider pericardiectomy for treatment.
Area of Science:
- Cardiology
- Hepatology
- Radiology
Background:
- Refractory ascites in liver cirrhosis patients can be challenging to manage.
- Transjugular intrahepatic portosystemic shunt (TIPSS) is a potential treatment for portal hypertension-related ascites.
Observation:
- Two patients with refractory ascites presented with dilated inferior caval and liver veins.
- Chest X-ray revealed pericardial calcifications, suggesting constrictive pericarditis.
Findings:
- Constrictive pericarditis was confirmed by cardiac catheterization showing a diastolic dip-plateau phenomenon.
- Successful treatment was achieved with pericardiectomy in one patient.
Implications:
- Dilated jugular and liver veins in refractory ascites patients warrant suspicion for constrictive pericarditis.
- Pericardial calcifications on chest X-ray aid in diagnosing constrictive pericarditis, preventing unnecessary liver disease workups.
- Early pericardiectomy is the preferred treatment, while shunt procedures are not indicated for this condition.