Reversible Advanced Liver Fibrosis in Pediatric Constrictive Pericarditis

Chronic constrictive pericarditis is a rare cause of heart failure in children and may present with nonspecific symptoms. Chronic venous congestion can result in liver injury mimicking cirrhosis.

An 8-year-old boy presented with exercise intolerance, dyspnea, and longstanding gastrointestinal symptoms leading to a diagnostic delay of nearly 5 years. Evaluation revealed hepatomegaly and advanced liver fibrosis (METAVIR F4) on elastography, despite preserved liver function. Multimodality cardiac imaging demonstrated features consistent with constrictive pericarditis. The patient underwent successful pericardiectomy. At 3-month follow-up, liver stiffness regressed to METAVIR F1, indicating reversal of congestion-related fibrosis.

Diagnosis of pediatric constrictive pericarditis remains challenging. This case demonstrates that advanced fibrosis due to venous congestion may be reversible after correction of the underlying hemodynamic abnormality.

Constrictive pericarditis should be considered in children with systemic venous congestion. Timely surgical treatment may lead to reversal of liver fibrosis.