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Symptomatic pericardial constriction without active pericarditis.

Kevin Steel1, Steven J Duming, Chad DeMott

  • 1Department of Internal Medicine, Wright-Patterson Medical Center, Wright-Patterson Air Force Base, OH 45433-5529, USA.

Military Medicine
|September 22, 2005
PubMed
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Symptomatic pericardial constriction can occur even with a normal-appearing pericardium on imaging and biopsy. Pericardectomy successfully treated such cases, resolving constrictive hemodynamics and symptoms.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Diagnostic Imaging

Background:

  • Constrictive pericarditis diagnosis typically relies on imaging showing pericardial thickening or abnormalities.
  • Surgical pericardectomy is a definitive treatment for symptomatic constrictive pericarditis.

Observation:

  • A case of symptomatic pericardial constriction was observed despite normal computed tomography (CT) scans and pathological findings of the pericardium.
  • The patient presented with refractory symptoms, physical findings, and intracardiac pressures indicative of constrictive pericarditis.

Findings:

  • Pericardectomy was performed, leading to the resolution of constrictive hemodynamics.
  • Post-operative symptoms significantly improved, indicating successful treatment.

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Implications:

  • Normal pericardial imaging and biopsy results should not rule out pericardectomy in patients with clear clinical and hemodynamic evidence of constrictive pericarditis.
  • This case highlights the importance of clinical judgment and considering pericardectomy even with seemingly normal pericardial tissue.
  • Further investigation into the underlying causes of constriction in histologically normal pericardium may be warranted.