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Constrictive pericarditis masquerading as Budd-Chiari syndrome
A Arora1, N Tandon, M P Sharma
1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi.
Insights
Constrictive pericarditis can mimic Budd-Chiari syndrome, even without typical symptoms like high venous pressure. Echocardiography or CT scans are crucial for diagnosing constrictive pericarditis and avoiding unnecessary invasive procedures for Budd-Chiari syndrome.
Area of Science:
- Cardiology
- Hepatology
- Diagnostic Imaging
Background:
- Budd-Chiari syndrome (BCS) and constrictive pericarditis (CP) present with overlapping clinical signs.
- Differentiating between BCS and CP is critical for appropriate patient management.
Observation:
- Three recent cases highlighted CP clinically mimicking BCS.
- Two patients with CP lacked elevated jugular venous pressure, a common BCS sign.
- One severe case of CP resulted in fatal jaundice and hepatic coma.
Findings:
- Liver biopsy findings were inconclusive in distinguishing between BCS and CP.
- Echocardiography, chest CT, and cardiac catheterization were definitive for diagnosing CP.
- Noninvasive imaging proved superior to invasive liver biopsy in these specific cases.
Implications:
- Atypical presentations of apparent BCS warrant investigation for constrictive pericarditis.
- Noninvasive diagnostic tests like echocardiography and chest CT should precede invasive procedures.
- Early diagnosis of constrictive pericarditis can prevent misdiagnosis and guide timely, potentially life-saving treatment.
Abstract:
Budd-Chiari syndrome (BCS) and constrictive pericarditis (CP) share many common clinical features. Over the last year we encountered three patients in whom CP clinically mimicked BCS. Two of the three did not even have raised jugular venous pressure. One patient with severe jaundice and hepatic coma ultimately died. Liver biopsy features were not discriminating. The final diagnosis of CP was established by echocardiography, chest computed tomography (CT), or cardiac catheterization. We conclude that in all patients with apparent BCS and atypical features, a noninvasive test like echocardiography or chest CT should be done to rule out treatable illness like CP before embarking on such invasive procedures as liver biopsy for diagnosis.