Abstract 14114: An Extreme Case of Calcific Constrictive Pericarditis

Introduction: Constrictive pericarditis (CP) can lead to cardiac dysfunction and a range of clinical symptoms. However, differentiating it from conditions like restrictive cardiomyopathy can be challenging due to the overlapping features.

Case Presentation: We present a case of a 61-year-old female with a history of atrial flutter and subsequent atrial fibrillation, experiencing worsening dyspnea on exertion, lip cyanosis, and upper abdominal constriction. Extensive diagnostic workup, including Echo, CT scan, and cardiac MRI, revealed severe biatrial enlargement, ventricular interdependence, elevated filling pressures, reduced cardiac output, and extensive pericardial thickening and calcifications ( Figures 1.a and 1.b ). These findings supported the diagnosis of extensive CP.

Discussion: CP is often missed and delayed in diagnosis due to its complex hemodynamics and the non-specific symptoms. Typically, the initial imaging modality to be performed is an Echo. Specific findings such as dilated vena cava, preserved tissue velocity with annuls paradoxus, abnormal respiratory septal shift, and respiratory variations in mitral/tricuspid inflow should be first clues for potential diagnosis. Furthermore, evaluation of the hepatic vein with diastolic flow reversal during expiration is a key finding. Lack of respiratory variation in the SVC is also important. Cardiac CT will assess pericardial thickness and calcification, while cardiac MRI is key for the diagnosis by showing the pericardial thickness and fibrosis as well as the septal respiratory shift and venous congestion. An invasive hemodynamic study might be required if imaging is inconclusive. this patient’s presentation, imaging findings, exercise test results and collectively supported considering radical pericardiectomy.

Conclusions: This report highlights the diagnostic challenges related to CP and the importance employing a multimodality imaging approach for accurate diagnosis.