Identifying Constrictive Pericarditis With Multimodality Imaging: A Diagnostic Challenge

Constrictive pericarditis is a chronic inflammatory process characterized by scarring, fibrosis, and calcification of the pericardium which often progresses to diastolic dysfunction, low cardiac output, and heart failure.

We report a case of a 35-year-old man presenting with dyspnea, orthopnea, and edema for 9 months who was ultimately diagnosed with idiopathic constrictive pericarditis. He underwent successful pericardiectomy with relief of symptoms and volume overload.

Constrictive pericarditis is a potentially curable form of heart failure with pericardiectomy. Diagnosis is confirmed by echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and invasive hemodynamic evaluation. The clinical diagnosis in this patient was delayed by discordant results from multimodality imaging. This report underscores the clinical challenge of making a diagnosis of a rare disease despite multimodality imaging.

In patients presenting with clinical symptoms of heart failure and preserved left ventricular ejection fraction, constrictive pericarditis is one of the potential etiologies.