A cursed duet-a case of tuberculous effusive-constrictive pericarditis

Effusive constrictive pericarditis (ECP) is a syndrome of combined pericardial effusive and constrictive physiology. Historically, it was a rare diagnosis which required invasive cardiac catheterisation confirmation post drainage of the pericardial effusion. However, the emergence of reliable echocardiographic features of constrictive disease has improved diagnostic yield.

We present a case of a 34-year-old patient with a pericardial effusion secondary to tuberculous pericarditis which demonstrated constrictive features on echocardiogram pre-pericardiocentesis and on invasive cardiac catheterisation measurements post pericardiocentesis - consistent with ECP. Ultimately this patient required a pericardiectomy for refractory symptoms of right heart failure despite pericardiocentesis.

We utilise this case to highlight the rare clinical entity of ECP but also to demonstrate the complex haemodynamics which govern pericardial effusions, constrictive pericarditis and ECP.