scholarly journals P647 Constrictive pericarditis - a rare entitiy, often missed

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
NILESH Banthia ◽  
D R Banthia
Keyword(s):  
Mitral Valve ◽  
Constrictive Pericarditis ◽  
Vena Cava ◽  
Abdominal Distension ◽  
Tissue Doppler ◽  
Doppler Velocity ◽  
Wall Thickening ◽  
Hepatic Veins ◽  
Complete Work ◽  
Eyes Open

Abstract Funding Acknowledgements No funding OnBehalf no group Case of a 14 yrs old girl, presenting with abdominal distension, odema feet and occasional dyspnoea. Evaluated with USG abdomen s/o hepatomegaly, ascitis, and GB wall thickening, blood reports all normal, including LFT, CBC, creatinine, and TSH. Pt had no h/o fever, or cough, dyspnoea, loose motions, jaundice. ECG and CXR were also normal. Started on diuretic with some response but odema and abdominal distension persisted, so admitted to our hospital after 4-5 months of illness for complete work up of her disease. We did echocardiography which showed dilated RA and LA, with septal bounce, and variation in Mitral Valve Doppler velocities with respiration, also annulus reverses, with Lateral MV tissue Doppler velocity being less than the medial Mitral Valve annulus , also there was Inferior Vena Cava plethora, with dilated hepatic veins, with flow reversal in it with expiration. Also the pericardium was thickened and measured 5mm in a small girl. All these findings went in favour of constrictive pericarditis. We went ahead and did cardiac MRI, which confirmed our findings and showed pericardium being thickened, 5mm, and septal bounce. Also there were e/o mediastinal nodes. All these went in favour of constrictive pericarditis, with Kochs as the cause. This has been diagnosed recently on 13 th December only and now we have started the pt on steroids with Anti Tuberculosis Treatment and waiting for her response. This is being presented for the rarity of the disease, and how we need to keep on doing investigations and keep our eyes open of a rare disorder, to be diagnosed and relieve the patient of its symptoms.

scholarly journals 639 A case of acute transient constrictive pericarditis—an unusual presentation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Paolo Marco Pietro Spissu ◽  
Simone Angius ◽  
Maria Francesca Marchetti ◽  
Ludovica Caggiari ◽  
Alessandra Gioi ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Vena Cava ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Acute Pericarditis ◽  
Echocardiographic Examination ◽  
Mild Reduction ◽  
Chest X Ray ◽  
Anti Inflammatory

Abstract Aims Transient constrictive pericarditis (TCP) is a rare manifestation which can occur in up to 15% of cases of acute pericarditis and most have resolution after 3 months of anti-inflammatory therapy. Methods and results We present the case of a young guy who showed up at our emergency department complaining of pericarditic chest pain and fever up to 39 °C degrees since the previous 4 days. After physical examination, electrocardiogram, blood tests, chest X-ray, and echocardiography acute pericarditis with severe pericardial effusion (more than 20 mm of thickness) were diagnosed and an empiric anti-inflammatory therapy with ibuprofen and colchicine was started. After 2 weeks of therapy, patient was not clinically improving with a worsened pericardial effusion and only a mild reduction of inflammatory markers. During an echocardiographic examination, features of constrictive physiology were discovered: respirophasic interventricular septal shift, increased respiratory variation of the mitral and tricuspidal inflow, plethoric inferior vena cava, and ‘annulus reversus’ and ‘annulus paradoxus’ on Tissue Doppler Imaging (TDI). Cardiac magnetic resonance (CMR) was also performed to confirm the diagnosis of acute pericardial constriction: it revealed increased T2-weighted imaging signal and increased Delayed Gadolinium Enhanced (DGE) signal, respectively consistent with oedema and with neovascularization, both suggestive of acute pericardial inflammation. Therefore, oral low doses corticosteroid was started After 2 weeks course of ‘triple therapy’ the patient was clinically improved and the echocardiographic features of constrictive physiology were no longer present thus allowing his discharge and the continuation of therapy at home. Conclusions This case was remarkable because it showed that constrictive pericarditis may present in a reversible form with medical therapy, this meaning it is due to pericardial oedema, inflammation and fibrin deposition similar to acute pericarditis rather than the pericardial fibrosis and calcification more commonly seen in chronic pericardial constriction.

scholarly journals P1484 Unusual manifestation of constrictive pericarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Golinska Grzybala ◽  
A Gackowski
Keyword(s):  
Right Ventricle ◽  
Ct Scan ◽  
Constrictive Pericarditis ◽  
Vena Cava ◽  
Thick Layer ◽  
Lv Function ◽  
Hepatic Veins ◽  
Heart Team ◽  
Fatty Tissue ◽  
The Right

Abstract Introduction The objective of this case report is to highlight the difficulties in establishing the proper management in some patients with chronic constrictive pericarditis (CCP). Case Description A 67 year-old-man with a long history of COPD (stage D), coronary heart disease, diabetes mellitus type 2, prostate cancer treated with local radiotherapy and hormonotherapy, was admitted due to progressive fatigue and dyspnoea on exertion,. Three months before he was hospitalised in pulmonary ward because of sudden onset of severe dyspnoea with mild leg oedema, and unusually weak response for typical COPD treatment was observed. At this time local lab test revealed moderately elevated CRP (43.6 mg/l), ESR (36 mm) and NT-proBNP (483 pg/ml). CT scan was performed to exclude pulmonary embolism. No pericardial calcifications were noted. Physical examination showed obesity (33 kg/m2), heato-jugular reflux and mild ankle oedema. Chest auscultation revealed normal lungs sounds and muffled heart sounds. Pleural effusion was excluded and no ascites nor hepatomegaly was found. Echocardiography revealed typical changes for CCP prominent septal bounce during inspiration, annulus reversus (TDI e` lat 16 cm/sek; e` med 18 cm/sek), annulus paradoxus (E/e` 8), normal LV function, dilated vena cava inferior (VCI). MRI showed thickened pericardium (5mm) particularly near the right ventricle (RV) and thick layer of fatty tissue (15 mm) localised in pericardium, next to the RV free wall. RV was compressed (fig.1). LVEF was 63%, EDV 117 ml, SV 74 ml, SVi 33 ml/m2, LV mass 78 g; RV EF 71%, EDV 72 ml/m2, right atrium enlargement was found (38 cm2), while left atrium was of normal size (22 cm2). VCI and hepatic veins were dilated (29 mm and 13mm respectively. Fig 1. MRI – thickened pericardium containing thick fatty tissue causin with RV compression After diuretic uptitration, the dyspnoea improved to NYHA I/II. Due to clinical improvement heart team decided to continue medical treatment. Due to comorbidities (DM, COPD, obesity), the risk of pericardiectomy was considered high. Three month later the patient was hospitalized due to sudden dyspnoea and subsequent cardiac arrest. Despite cardiopulmonary resuscitation the patient died in ICU. CCP was confirmed in autopsy. Discussion The diagnosis of CCP remains challenging. In this case the presentation was not fully typical. There was no clear precipitating factor, the history was relatively short and the symptoms and signs mild. CT scan did not show pericardial calcifications. Although TTE revealed typical features of CCP and MRI confirmed compression of the right ventricle, the heart team did not confirm the need for pericardiectomy, which is treatment of choice in progressive CCP. Abstract P1484 Figure. Fig.1

scholarly journals Constrictive pericarditis presenting with massive ascites without hemodynamic echocardiographic features

2017 ◽  
Vol 4 (1) ◽  
pp. 54
Author(s):  
Hasan Ashraf
Keyword(s):  
Cardiac Catheterization ◽  
Constrictive Pericarditis ◽  
Vena Cava ◽  
Abdominal Distension ◽  
Good Sensitivity ◽  
Characteristic Finding ◽  
Mitral Inflow ◽  
History Of ◽  
Diagnostic Modalities ◽  
Echocardiographic Findings

A 27-year-old woman presented to the hospital because of a five-month-history of rapidly-accumulating ascites, dyspnea, and fatigue. The patient was otherwise asymptomatic, and required repeated large volume paracenteses. Physical exam was benign except for hepatomegaly and abdominal distension. Laboratory testing demonstrated elevation of transaminases, but further testing was all negative. A chest CT showed pericardial thickening. Subsequent echocardiography was performed to evaluate for constrictive pericarditis, but apart from inferior vena cava (IVC) dilation, there were no other findings suggestive of pericardial constriction. A subsequent cardiac catheterization was suggestive of constrictive pericarditis, so the patient underwent a pericardiectomy. The Mayo Clinic echocardiography diagnostic criteria presents a diagnostic paradigm where the presence of mitral inflow E/A > 0.8 and the presence of a dilated IVC concomitantly provide good sensitivity for echocardiographic diagnosis of constrictive pericarditis (CP). Due to the good sensitivity and specificity of echocardiographic findings, the lack of any characteristic finding is surprising, and suggests the importance of other diagnostic modalities such as CT, cardiac MRI, and cardiac catheterization in conjunction with echocardiography when there is a high suspicion for CP. 

scholarly journals An unusual cause of refractory ascites with cirrhosis

2016 ◽  
Vol 4 (1) ◽  
pp. 297
Author(s):  
Nikhil Mehra ◽  
Poonam Sherwani
Keyword(s):  
Constrictive Pericarditis ◽  
Vena Cava ◽  
Control Program ◽  
Refractory Ascites ◽  
Hepatic Veins ◽  
Cardiac Symptoms ◽  
Doppler Study ◽  
National Tuberculosis ◽  
Oral Steroids ◽  
Surgery Department

Reports of chronic constrictive pericarditis presenting with hepatomegaly, cirrhosis and ascites but no cardiac symptoms are rare. A 10 year old child presented with refractory ascites and firm hepatomegaly of 2 years duration which partially responded to diuretics. Doppler study showed dilated hepatic veins and inferior vena cava and ruled out hepatic venous outflow tract obstruction. Chest X ray showed pericardial calcification and 2D Echo was suggestive of chronic constrictive pericarditis. A diagnosis of chronic calcified constrictive pericarditis with cirrhosis and refractory ascites was made. Based on previous series which showed that tuberculosis is the most common cause of constrictive pericarditis, tuberculosis as the cause of constrictive pericarditis was kept. Anti tuberculous treatment as per Revised National Tuberculosis Control Program guidelines was started along with oral steroids and diuretics. Child showed response to the treatment and was later referred to cardiac surgery department for further management (pericardectomy).  

scholarly journals Obstruction of the Hepatic Venous Flow Caused by Intravenous Leiomyomatosis

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 696
Author(s):  
Sin-Youl Park ◽  
In Hwan Yeo ◽  
Yun Jeong Kim ◽  
Jong Kun Kim
Keyword(s):  
Early Recognition ◽  
Rare Complication ◽  
Vena Cava ◽  
Pelvic Mass ◽  
Abdominal Distension ◽  
Hepatic Veins ◽  
Intravenous Leiomyomatosis ◽  
Venous Flow ◽  
Bedside Ultrasonography ◽  
The Right

Budd–Chiari syndrome (BCS) is a rare intrahepatic vascular disease that is characterized by a hepatic venous outflow obstruction. Intravenous leiomyomatosis (ILs) is a rare complication of a myoma. Here, we report a case of BCS that was caused by intracaval ILs. A woman presented to the emergency department (ED) with abdominal distension that had gradually progressed over a period of 3 years. Bedside ultrasonography and contrast-enhanced computed tomography (CECT) showed a large ascites and pelvic mass. The mass continued to the inferior vena cava and the right atrium. The intracaval mass was obstructing the left and middle hepatic veins. We established a tentative diagnosis of BCS caused by intracaval ILs and attempted surgical resection. Complete resection of the intracaval mass failed because of adhesion; however, she was discharged from the hospital without any postoperative complications. After 3 months, a pelvic ultrasonography showed a recurrence of a 4 × 3 cm pelvic mass. The mass size increased to 6 cm after 30 months. ILs can cause secondary BCS and can lead to life-threatening conditions. Owing to its extreme rarity, early detection in the ED is challenging. Bedside ultrasonography and CECT can enable the early recognition of BCS by ILs.

scholarly journals Acute Budd Chiari Syndrome

2014 ◽  
Vol 31 (4) ◽  
pp. 223-226
Author(s):  
AFMH Uddin ◽  
M Wareshuzzaman ◽  
RK Banik ◽  
SK Saha ◽  
NC Nath ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Vena Cava ◽  
Protein S ◽  
Abdominal Distension ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Abdominal Ultrasonography ◽  
Factor Deficiency ◽  
Chiari Syndrome ◽  
The Right

Budd-Chiari syndrome (BCS) is a rare disease in population characterized by hepatic venous outflow obstruction at a site that may vary from the level of the small hepatic veins up to the junction of the inferior vena cava with the right atrium . Here we presented a case of 35 year old male who presented with abdominal pain, abdominal distension and leg oedema . Subsequent physical examination, laboratory data, abdominal ultrasonography and duplex study all confirmed the diagnosis of BCS with Protein C , protein S , and antithrombin III deficiency . But we were unable to detect whether these factor deficiency were primary or secondary. Genetic study may be used to elucidate the cause. Whether primary or secondary, standard protocol should be used to treat Budd Chiari syndrome with these factor deficiency. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21009 J Bangladesh Coll Phys Surg 2013; 31: 223-226

Budd-Chiari syndrome in a kitten, caused by membranous obstruction of the caudal vena cava

1995 ◽  
Vol 31 (6) ◽  
pp. 484-491 ◽  
Author(s):  
DK Macintire ◽  
RH Henderson ◽  
C Banfield ◽  
RP Kwapien
Keyword(s):  
Vena Cava ◽  
Small Animal ◽  
Volume Overload ◽  
Abdominal Distension ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Patch Graft ◽  
Dacron Patch ◽  
Stenotic Segment

An eight-month-old, male domestic shorthair kitten developed progressive abdominal distension over a six-week period. Abdominocentesis revealed a fluid with high protein (3.8 g/dl) and moderate cellularity. Infectious, cardiovascular, and neoplastic causes of posthepatic obstruction were ruled out. Partial obstruction and stenosis of the caudal vena cava (CVC) at the level of the diaphragm were detected on a contrast venogram. Exploratory surgery revealed a fibrous, web-like membrane at the site of obstruction. Resection of the stenotic segment of the CVC was not possible because of the junction of the left hepatic veins and CVC just caudal to the lesion. A 3 by 6-mm, oval Dacron patch graft was sutured into the venotomy site. Postoperative complications included fever and leukocytosis, eosinophilic pleural effusion, and transient congestive heart failure associated with volume overload. The cat is normal 16 months after surgery, with no recurrence of ascites. This is the first reported case of Budd-Chiari syndrome (BCS) in a domestic kitten. Documented herein is the first successful treatment of BCS in a small animal using a vascular, prosthetic patch graft.

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