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A rare cause of constrictive pericarditis
Shane Patrick Flood1, Omar Ayah1, Satoshi Furukawa2
1Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
BMJ Case Reports
|January 20, 2017
Summary
This case highlights a rare presentation of metastatic signet ring adenocarcinoma mimicking constrictive pericarditis. Early diagnosis and intervention are crucial for managing such complex cardiac conditions.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Constrictive pericarditis can present insidiously with symptoms mimicking heart failure.
- Metastatic malignancy to the pericardium is an uncommon but critical differential diagnosis.
Observation:
- A 67-year-old man presented with exertional dyspnea, edema, and signs of cardiac tamponade.
- Initial investigations including echocardiography, CT, and fluid analyses were inconclusive.
- Recurrent effusions and progression to constrictive pericarditis were noted despite initial interventions.
Findings:
- Histopathology after pericardiectomy revealed metastatic poorly differentiated signet ring adenocarcinoma of intestinal origin.
- The patient's condition was ultimately attributed to malignancy, not a primary pericardial disease.
Implications:
- This case underscores the importance of considering occult malignancy in unexplained pericardial disease and constrictive pericarditis.
- Aggressive diagnostic workup, including intraoperative frozen sections, may be necessary to identify rare etiologies.
- Timely recognition of metastatic disease is vital for appropriate patient management and prognosis.
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