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Constrictive Pericarditis in a Hemodialysis Patient Who Presented with Rapidly Progressive Pericardial Calcification:
Oho Tsunematsu1,2, Shin-Ichi Takeda1,2, Mitsutaka Yamaguchi1
1Division of Nephrology, Department of Internal Medicine, Haga Red Cross Hospital, Moka, Japan.
Insights
Diagnosing constrictive pericarditis (CP) in hemodialysis patients is challenging. This case highlights progressive pericardial calcification as a key diagnostic clue for CP, enabling timely intervention and successful surgical management.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Constrictive pericarditis (CP) impairs ventricular diastolic filling, often leading to right heart failure.
- Diagnosis can be difficult due to overlapping symptoms with other conditions.
- Prompt diagnosis and treatment are critical for hemodialysis patients to prevent severe hypotension and dialysis complications.
Purpose of the Study:
- To report a challenging case of constrictive pericarditis in a hemodialysis patient.
- To highlight the diagnostic utility of progressive pericardial calcification.
- To discuss the management of hemodialysis patients with severe hypotension secondary to CP.
Main Methods:
- Case report of a 53-year-old male on hemodialysis presenting with shock and presyncope.
- Computed tomography (CT) imaging to evaluate progressive pericardial calcification.
- Cardiac catheterization to assess right ventricular pressure dynamics (dip-and-plateau pattern).
Main Results:
- The patient presented with severe hypotension (55/30 mm Hg) and persistent right pleural effusion despite hemodialysis.
- CT revealed progressive, pericardium-confined calcification over time.
- Cardiac catheterization confirmed constrictive pericarditis via a characteristic dip-and-plateau pattern.
Conclusions:
- Progressive pericardial calcification can be a crucial diagnostic indicator for constrictive pericarditis in hemodialysis patients.
- Early diagnosis and surgical intervention led to successful treatment.
- This case offers insights into managing hemodialysis patients with hypotension and suspected CP.
Introduction:
Constrictive pericarditis (CP) is characterized by impaired diastolic filling of the ventricles, which typically causes right heart failure. Its diagnosis may be challenging because it mimics other disorders. Furthermore, prompt diagnosis and treatment are more crucial in cases of hemodialysis; otherwise, maintenance dialysis would be hampered by severe hypotension.
Case Presentation:
We report the case of a 53-year-old man on hemodialysis who developed CP with shock. His blood pressure was 55/30 mm Hg at the time of hospitalization due to presyncope. He continued hemodialysis but with some difficulty. However, right pleural effusion persisted because of impaired fluid removal by hemodialysis. Despite such severe manifestations, the distinctive clinical features of CP were lacking. By carefully evaluating the time course of computed tomography images, progressive calcification in the pericardium emerged as a significant clue. Cardiac catheterization subsequently revealed a dip-and-plateau pattern of right ventricular pressure, which led to a definitive diagnosis of CP. Soon after the diagnosis, he underwent successful surgery.
Conclusion:
An important finding was that, unlike calcific lesions in the general dialysis population, the patient's calcific lesions were mostly confined to the pericardium and progressed on a monthly basis. Thus, the present case may provide deep insight into the diagnosis of CP and the management of hemodialysis patients with severe hypotension.
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