'Egg-cased heart': a multimodality imaging approach to chronic constrictive pericarditis with egg-shell...

Area of Science:

• Cardiology
• Radiology
• Thoracic Surgery

Background:

• Constrictive pericarditis (CP) results from chronic pericardial inflammation.
• Pericardial calcification is common in CP, but extensive egg-shell calcification is rare.
• This case highlights diagnosing chronic constrictive pericarditis (CCP) with extensive calcification.

Observation:

• A middle-aged female presented with right heart failure symptoms.
• Diagnosis of CP was confirmed via echocardiography and cardiac catheterization.
• A CT scan revealed extensive egg-shell like calcification encasing the heart.

Findings:

• The patient underwent pericardiectomy via median sternotomy.
• Post-surgery, the patient remains asymptomatic.
• The extensive calcification required a specific surgical approach.

Implications:

• Preoperative CT imaging is vital for defining calcification extent and guiding surgical strategy in calcific CP.
• Median sternotomy is preferred over anterolateral thoracotomy for extensive calcific CP to minimize incomplete resection.
• Multi-modality imaging is paramount for optimal management of complex constrictive pericarditis.