Medical image of the week: constrictive pericaditis

Abstract

A 62-year-old woman, with a past medical history significant for oxygen dependent COPD, paroxysmal atrial fibrillation, and obstructive sleep apnea, presented to the hospital with hypoxemic respiratory failure requiring intubation and mechanical ventilation. A computerized tomography of the chest revealed cardiomegaly, bilateral pleural effusions, and pericardial calcification that was noted diffusely with focal regions of pericardial thickening greater than 4 mm. A cardiac catheterization revealed elevated right-sided pressure; markedly elevated left ventricular end diastolic pressure; equalization of LV-RV diastolic pressures; and sharp Y descent on the right atrial pressure waveform; which is all suggestive of constrictive physiology. The patient was medically optimized and diuresed and eventually underwent a successful pericardiectomy.

Keywords

• constrictive pericarditis
• CT scan
• thoracic CT scan
• pericardial calcification
• cardiac catherization
• equalization of diastolic pressures
• pericardectomy
• respiratory failure
• end diastolic pressure
• elevated end diastolic pressure