Transient constrictive pericarditis: diagnosis by two-dimensional Doppler echocardiography

Patients with constrictive pericarditis usually require pericardiectomy to relieve their symptoms. In some patients, however, constrictive pericarditis may resolve spontaneously or with medical treatment. Four patients with transient constrictive pericarditis are described in this report. Although the cause of pericarditis differed, all patients had a small to large amount of pericardial effusion, followed by symptoms, signs, and Doppler features typical of constrictive pericarditis. Symptomatic improvement occurred after treatment with some combination of nonsteroidal anti-inflammatory agents, corticosteroids, and antibiotics. The resolution of the symptoms paralleled the normalization of characteristic respiratory changes in Doppler flow velocities. The condition of our patients most likely was related to a transient inflammation (or thickening) of the pericardium due to viral, bacterial, or immunologically mediated pericarditis. Resolution of the thickened pericardium was documented by magnetic resonance imaging in one patient. Awareness of the possible transient nature of constrictive pericarditis in a subgroup of patients with constriction has important clinical implications when pericardiectomy is considered. The resolution of constrictive pericarditis can be documented by serial Doppler echocardiographic examination.