Constrictive Pericarditis with Extensive Calcification and Caseous Necrosis (original) (raw)
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Constrictive pericarditis with extensive calcification
Arquivos brasileiros de cardiologia, 2011
A patient with signs and symptoms of right heart failure of unknown etiology was referred to a referral hospital in the eastern area of the city of São Paulo with a diagnosis of calcified constrictive pericarditis and was treated by surgery. This pathology is characterized by an irreversible process of pericardium calcification, and surgery is the only alternative to control the symptoms and improve patients' quality of life. This case drew special attention due to the extensive calcification involving the interventricular septum. The unusual aspect of the images has made the diagnosis difficult and raised doubts about the existence of an associated disease.
2021
Constrictive pericarditis refers to inflammation of the pericardial sac, possibly leading to acute heart failure. More than 80% cases are presumed to be due to recent or remote viral illnesses. Prominent features include chest pain, dyspnea and electrocardiogram (ECG) revealing P-R segment depression, diffuse concave ST segment elevation, and T-wave inversion. Echocardiogram and cardiac magnetic resonance imaging (MRI) can help establish diagnosis. Over time, the pericardium can undergo fibrosis or calcification resulting in excessive symptoms. After medical management with ibuprofen, colchicine or steroids, partial or complete pericardiectomy is considered. We are presenting a case with constrictive pericarditis due to extensive pericardial calcification, and ultimate resolution with pericardiectomy.
Strangulation of Heart Due to Calcified Constrictive Pericarditis Causing Right Heart Failure
Background: Constrictive Pericarditis (CP) results from fibrosis and calcification of pericardium. CP can be present with the assemblage of symptoms due to strangulation of heart. However, right heart failure due to localized calcified CP is exceptionally unmatched. Case Report: A 32-year-old female patient hailing to our hospital with the complaint of dyspnea, right upper abdominal pain, ascites, and bilateral pedal edema in May 2018. After proper investigation, she diagnosed with subacute right heart failure due to localized calcified CP. Therefore, she managed with diuretic therapy and symptomatic treatment. After one year, she suddenly present in the emergency department with the features of right heart failure. Her New York Heart Association (NYHA) score was class-III. After proper medical management of her symptoms, she underwent off-pump partial pericardiotomy with no complaints. Analgesics, Antibiotics, and diuretics were administered in the post-operative period. She was discharged on the 6th post-operative day with no symptoms of right heart failure. Conclusion: Herein, we report a very unusual presentation with localized CP, causing strangulation of heart, which had been treated successfully with off-pump partial pericardiotomy. Meticulous dissection is the key to a successful pericardiotomy.
Severe calcific constrictive pericardiectomy operation: ‘Hearts of stone’
E Journal of Cardiovascular Medicine, 2016
Background: Dense constrictive pericarditis, ''Hearts of stone'' is a rare condition characterized by limitation of myocardium due to a massive fibrosis and calcification of the pericardium. The aim of this study was to research the literature to discuss the surgical intervention and management of densely calcified constrictive pericarditis. Methods: Over a seven-year period, 19 consecutive patients who underwent pericardiectomy operation for severe constrictive pericarditis reviewed to determine reasons, surgical techniques, mortality and morbidity rates, and improvement of functional capacity. We freed the anterior pericardium from phrenic nerve to phrenic nerve. In two cases, we used a rongeur to break down the dense calcification. The indications for pericardiectomy were tuberculous in 4 cases (21%), idiopathic-fibrous in 11(57.8%), rheumatic in 2(10.5%), uremic in 1(5.2%), and neoplastic in 1(5.2%). Results: Inpatients mortality ratio was 5.2% in case of isolated severe calcified pericardiectomy. Ascites in 3 patients (15.7%), hepatomegaly in 4 (21%) and peripheral edema in 15 (78.9%) were found on their physical examination. In the 1st postoperative month follow up, dramatically improvement of preoperatively functional capacity were the number of cases in New York Heart Association class IV (worse general condition) moved from 14 to II; in class III from 4 to II; in class II from to I in one case. In our all series, idiopathic-fibrous was the most frequent cause of chronic severe constrictive pericarditis, but the second most common tuberculous pericarditis was increasing overall. Postoperative and neoplastic pericarditis were rare. Conclusion: The preoperative clinical conditions and functional status at follow-up was improved in all cases. We recommended that the orthopedic surgical instrument, 'rongeur', is very useful to cut that totally calcified tissue.
Journal of College of Medical Sciences-Nepal, 2012
Constrictive pericarditis is a debilitating but potentially curable disease. Diffuse pericardial thickening and calcification is a classic feature described; localized pericardial constrictions are very rare. Here we report a case of a young female who had presented with constrictive pericarditis and had localized calcific constrictive band located at the level distal to atrioventricular groove which had caused right midventricular obstruction. In many patients the cause of the pericardial disease is undetermined, and in them an asymptomatic or forgotten bout of viral or tubercular pericarditis, acute or idiopathic, may have been the inciting event. Our patient had pulmonary tuberculosis during childhood and received antituberculous treatment. Investigations revealed the presence of thickened pericardium and a thickened calcific constrictive band around the right ventricles at midventricle level causing midventricular obstruction. She was referred to another centre for further surgi...
Atypical Chest X-Ray Calcification in an Idiopathic Constrictive Pericarditis Case
Case Reports in Cardiology, 2013
Constrictive pericarditis is an uncommon cause of heart failure. It is a clinical entity caused by thickening, fibrosis, and/or calcification of the pericardium. We present a 50-year-old female patient who was admitted to our institution with a 6-month history of progressive dyspnea on exertion, abdominal swelling, and lower extremity edema. Her chest X-ray revealed an oblique linear calcification in the cardiac silhouette. Transthoracic echocardiography revealed biatrial enlargement. Left ventricular size and systolic function were normal. Cardiac computed tomography revealed the pericardial thickening (>5 mm) and heavy calcification in left atrioventricular groove. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip, and plateau. Pericardiectomy was performed which revealed a thick, fibrous, calcified, and densely adherent pericardium constricting the heart. The postoperative period was uneventful and was in NYHA functional class I after 3 months.
Ring-shaped calcific constrictive pericarditis strangling the heart: a case report
International journal of emergency medicine, 2014
Constrictive pericarditis is caused by fibrosis and calcification of the pericardium, processes that inhibit diastolic filling of the heart. For the diagnosis of constrictive pericarditis, a combined approach is used to evaluate the morphologic pericardial abnormalities in conjunction with assessment of the functional and hemodynamic changes. We report novel findings of chest computed tomography (CT) and chest roentgenogram with respect to a ring-shaped pericardial calcification on atrioventricular groove causing strangulation of the heart in the patient with constrictive pericarditis, which is anatomically rarer than other severe cases of constrictive pericarditis encasing the entire heart.
Constrictive Pericarditis with a Calcific Mass Invading into the Right Ventricular Myocardium
Echocardiography, 2013
We present a rare and unique case of calcific constrictive pericarditis with a calcified pericardial mass invading the right ventricular myocardium. Perioperative two-dimensional and three-dimensional transesophageal echocardiography revealed the extent and structure of the pericardial mass and led to the repair of the right ventricular free wall as a surgical intervention. (Echocardiography 2013;30:E4-E6)