Pericardial Metaplastic Ossification With Widespread Bone Formation: A Case Report

Pericardial disease can present clinically as acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis (CP). Pericardial calcification is present in less than 25% of all cases of CP, and patients with this finding are at risk for developing additional cardiac complications. A case of extensive pericardial ossification in a 65-year-old male presenting with pericardial effusion is reported. The patient had several episodes of pericardial effusion and was diagnosed with CP and subsequently managed on medical therapy. Due to worsening symptoms, additional investigations were completed, including echocardiogram, which revealed diastolic dysfunction with constrictive physiology. He underwent bilateral anterior pericardiectomy, and during the surgery, thickened, calcified, and adherent pericardium was identified, along with pockets of effusion. Cytology of pericardial fluid was negative for malignant cells. Histologic sections of the pericardium demonstrated extensive pericardial ossification with widespread bone formation in pericardial/epicardial adipose tissue. Idiopathic pericardial ossification, as identified in our case, is a rare phenomenon only described several times in the literature and may cause CP. Early intervention with pericardiectomy is a predictor of good outcome in CP, and thus, it is important to include rare entities such as metaplastic ossification in the differential for pericardial disease, to facilitate prompt diagnosis and surgical intervention.