Related Experiment Video
Updated: Jan 20, 2026
A Pleural Effusion Model in Rats by Intratracheal Instillation of Polyacrylate/Nanosilica
Published on: April 12, 2019
Misdiagnosis of constrictive pericarditis presenting with haemorrhagic pericardial effusion: a case report
Guoliang Li1, Peng Liu1, Dan Li2
1Arrhythmia Unit, Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, P.R. China.
Insights
Constrictive pericarditis (CP) is often misdiagnosed due to subtle symptoms. Early diagnosis via imaging and surgical pericardectomy can effectively treat this serious condition, even with large pericardial effusions.
Area of Science:
- Cardiology
- Internal Medicine
- Diagnostic Imaging
Background:
- Constrictive pericarditis (CP) presents with elusive symptoms, often leading to delayed diagnosis.
- A significant symptom-free period can precede the manifestation of CP after pericardial injury.
- Misdiagnosis is common due to the insidious onset of constrictive pericarditis.
Purpose of the Study:
- To highlight the diagnostic challenges and effective treatment of constrictive pericarditis.
- To present a case study illustrating the diagnostic pathway and successful management of CP.
- To emphasize the role of advanced imaging in diagnosing constrictive pericarditis.
Main Methods:
- A case report of a 58-year-old male with initial misdiagnoses including neuropathy and ischemic heart disease.
- Diagnosis of constrictive pericarditis confirmed through careful review of computed tomography scans.
- Surgical pericardectomy performed, followed by histopathological analysis of pericardial tissue.
Main Results:
- The patient presented with fatigue, chest tightness, and shortness of breath, initially misdiagnosed.
- Computed tomography revealed severe coronary artery stenosis, but the final diagnosis was constrictive pericarditis with massive hemorrhagic pericardial effusion.
- Histopathology confirmed chronic fibrinous pericarditis. Symptoms resolved post-pericardectomy, with no discomfort at 1-year follow-up.
Conclusions:
- Constrictive pericarditis is a frequently misdiagnosed serious condition.
- Computed tomography and echocardiography are crucial for diagnosing constrictive pericarditis.
- Surgical pericardectomy is a potentially effective treatment for constrictive pericarditis, though effusion mechanisms require further study.
Background:
The symptoms and signs of constrictive pericarditis (CP) are often elusive at onset, with a long symptom-free period that may take weeks to decades to develop after an episode of CP or pericardial injury, leading to a misdiagnosis.
Case Summary:
In this case, a 58-year-old man complained of lower extremity fatigue, intermittent chest tightness, and shortness of breath. He was first misdiagnosed as neuropathy, later unsuccessfully treated as ischaemic heart disease though severe stenosis of the diagonal branch of left anterior descending artery was confirmed by computer tomography angiography. He was finally diagnosed as CP after carefully reading the initial computed tomography. The gross pathology of heart in situ originally observed at the time of pericardectomy indicated fibrinous pericarditis, massive haemorrhagic pericardial effusion (300 mL), and thickened pericardium (maximum thickness more than 6 mm). Following pericardial tissue biopsy, the histopathology showed chronic fibrinous pericarditis, without a clear aetiology. His symptoms gradually disappeared after surgical pericardectomy. At the 1-year follow-up visit, the patient complained of no discomfort.
Discussion:
Constrictive pericarditis is one of the serious diseases commonly misdiagnosed. Computed tomography and echocardiography show the important diagnostic role in patients with CP, and surgical pericardectomy shows the potential in treating this disease, in some of which the mechanism underlying large haemorrhagic pericardial effusion remains unclear.
Related Concept Videos
03:48Behavior of Gas Molecules: Molecular Diffusion, Mean Free Path, and Effusion
01:22Pericarditis I: Introduction
01:25Pleural Effusion I: Introduction
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's...
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:25Pericarditis IV: Nursing Management
01:17Pericarditis III: Medical Management