Constrictive Pericarditis with Caseous Necrosis: A Rare and Underrecognized Presentation

Caseous necrosis of the mitral valve is the term used to describe the liquefaction of calcium present in its fibrous ring and the consequent formation of a pseudotumor with a thick, pasty content within. Although rare, this degenerative process has been widely described in the context of the mitral valve; however, it is little known in the context of constrictive pericarditis. We describe a series of seven cases that presented with constrictive pericarditis associated with caseous necrosis. Of the seven patients, six were male, with a mean age of 42±14 years, all in functional class III/IV, with clinical signs related to restrictive syndrome. Chest tomography showed intense pericardial calcification with caseous necrosis, confirmed by pericardiectomy.