Massive right pleural effusion and ascites caused by a primary constrictive pericardial band

A previously healthy 57-year-old woman with peripheral edema and exertional dyspnea had diminished right breath sounds and edema of both legs. Chest radiography showed massive right pleural effusion, and abdominal computed tomography showed ascites. During cardiac catheterization, pressure curves of both ventricles showed "dip-and-plateau" patterns. We diagnosed constrictive pericarditis and conducted pericardiectomy. During surgery, we found a thick fibrous pericardium surrounding the entire heart and a band of calcium in the atrioventricular groove. Histological examination of excised pericardial tissue showed fibrosis, hyalinization, and calcification, with thickening of < or = 18 mm. Cases of localized pericardial thickening, including constricting bands in the atrioventricular groove, are rare and many such complications occur postoperatively. We report a rare case of primary constrictive pericardial band resulting in massive right pleural effusion and ascites.