Overcoming diagnostic challenges in constrictive pericarditis: why volume is important?

Area of Science:

• Cardiology
• Hepatology
• Medical Imaging

Background:

• A 65-year-old male with chronic liver disease and refractory ascites presented diagnostic challenges.
• Constrictive pericarditis (CP) was suspected during liver transplant evaluation.
• Initial diagnostic attempts were confounded by diuretic-induced fluid status alterations.

Purpose of the Study:

• To investigate the diagnostic utility of multimodality imaging in a complex case of suspected constrictive pericarditis.
• To highlight the importance of optimizing volume status for accurate CP diagnosis.
• To report a case of successful pericardiectomy in a patient with co-existing liver disease.

Main Methods:

• Clinical evaluation of a patient with chronic liver disease and ascites.
• Diagnostic imaging, including cardiac magnetic resonance (CMR), was employed.
• Diuretic therapy was temporarily suspended to aid diagnosis.
• Surgical pericardiectomy was performed following diagnosis.

Main Results:

• Initial diagnostic workup was inconclusive due to overdiuresis.
• Cardiac MRI, performed after diuretic cessation, definitively confirmed constrictive pericarditis.
• Successful pericardiectomy led to normalization of liver function.
• The case underscores the critical role of volume status management and imaging in diagnosing CP.

Conclusions:

• Accurate diagnosis of constrictive pericarditis can be obscured by aggressive diuresis in patients with liver disease.
• Cardiac magnetic resonance is a valuable tool for diagnosing constrictive pericarditis, especially when other methods are inconclusive.
• Management of fluid balance is crucial for successful diagnosis and treatment of constrictive pericarditis in this patient population.