Asymmetric focal pericardial thickening causing physiologically significant constrictive pericarditis

Authors

  • Nauman Siddiqi MD,

    1. Division of Cardiology, Department of Medicine, University of California, Irvine, Orange, California
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  • Morton J. Kern MD, FACC,

    1. Division of Cardiology, Department of Medicine, University of California, Irvine, Orange, California
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  • Pranav M. Patel MD, FACC

    Corresponding author
    1. Division of Cardiology, Department of Medicine, University of California, Irvine, Orange, California
    • Division of Cardiology, University of California, Irvine, 101 City Drive, City Tower, Suite 400, Orange, CA 92868
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Abstract

A 34-year-old woman presented with refractory ascites and edema. Echocardiography revealed normal left ventricular function with a restrictive diastolic filling pattern. Tissue Doppler velocities of the mitral annulus were normal. Cardiac magnetic resonance imaging (MRI) revealed a focal region of pericardial thickening anterior to the right ventricle and normal thickness pericardium in the other segments. However, abnormal delayed enhancement MRI (consistent with inflammation) was present in both the thickened and the normal pericardial segments. Invasive hemodynamics confirmed constrictive physiology and the patient underwent successful pericardiectomy. This case highlights the utility of multimodality imaging in the diagnosis of constrictive pericarditis and the underappreciated fact that the pericardium need not be globally thickened to cause hemodynamically significant constrictive physiology.© 2012 Wiley Periodicals, Inc.

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