Calcified pericardial band at the level of right ventricle causing midventricular obstruction: a case report of constrictive pericarditis

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 surgical management. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 58-62 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6813

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Graft-versus-host disease: a case report of a rare but reversible cause of constrictive pericarditis

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa009 ◽

2020 ◽

Vol 4 (2) ◽

pp. 1-5

Author(s):

Christopher A Pieri ◽

Neil Roberts ◽

John Gribben ◽

Charlotte Manisty

Keyword(s):

Constrictive Pericarditis ◽

Hospital Admissions ◽

High Dose Chemotherapy ◽

Immunomodulatory Therapy ◽

High Dose ◽

Pericardial Disease ◽

Host Disease ◽

Graft Vs Host Disease ◽

Pericardial Thickening ◽

Small Pericardial Effusion

Abstract Background Constrictive pericarditis (CP), although an uncommon cause of heart failure, requires specialist multidisciplinary input and multi-modality imaging to identify the underlying aetiology and treat potentially reversible causes. Case summary We report the case of a 74-year-old gentleman referred for assessment of progressive exertional dyspnoea and peripheral oedema, 30 months following treatment of acute myeloid leukaemia with high-dose chemotherapy and allogeneic stem cell transplantation. Clinical examination and cardiac imaging revealed a small pericardial effusion and pericardial thickening with constrictive physiology; however, no aetiology was identified despite diagnostic pericardiocentesis. The patient required recurrent hospital admissions for intravenous diuresis, therefore, following multidisciplinary discussions, surgical partial pericardectomy was performed. Histology suggested graft-vs.-host disease (GvHD) and post-operatively, the patient improved clinically. Following immunomodulatory therapy with ruxolitinib for both pericardial and pulmonary GvHD, his functional status improved further with no subsequent hospital admissions. Discussion Although pericardial disease in cancer patients is common, CP is unusual. Determining the underlying aetiology is important for subsequent management, and here, we describe the use of multi-modality imaging to diagnose a rare cause, GvHD, which responded to surgical treatment and immunomodulatory therapy.

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A giant fibrinoid pericardial mass in a patient with rheumatoid arthritis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz061 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Felipe Cañas ◽

Juan David Lopez Ponce de León ◽

Juan Esteban Gomez ◽

Carlos Alberto Cañas

Keyword(s):

Rheumatoid Arthritis ◽

Right Ventricle ◽

Chronic Inflammatory Disease ◽

Pericardial Disease ◽

Prognostic Features ◽

Cardiac Manifestation ◽

Histopathological Studies ◽

The Right ◽

Pericardial Mass ◽

Pericardial Thickening

Abstract Background Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, which may extend to extra-articular organs. Extra-articular manifestations have been considered as prognostic features in RA, and pericardial disease is one of the most frequent occurrences. Rheumatoid arthritis pericarditis is usually asymptomatic and is frequently found on echocardiography as pericardial thickening with or without mild effusion. Severe and symptomatic cases are rare, but pericardial masses are even rarer. We report a patient with erosive, nodular seropositive RA, and progressive functional deterioration owing to a giant pericardial mass compressing the right cardiac chambers. Case summary The patient was a 79-year-old man. Cardiac magnetic resonance imaging revealed a pericardial lesion measuring 10 × 9 × 6 cm with complex structures in its interior, which had compressive effects on the right atrium and right ventricle, severely limiting diastole. Late gadolinium enhancement of the lesion walls and pericardium suggested pericarditis. Surgical resection was performed, and a soft mass with liquid content was extracted. The patient recovered well with improvements in symptoms and the functional status. Histopathological studies ruled out neoplasm, vasculitis, and infection, and the entire mass showed fibrinoid material associated with fibrinoid pericarditis. Discussion Symptomatic RA pericarditis is a rare cardiac manifestation of RA, whilst associated significant haemodynamic compromise is even rarer. The condition could manifest with a giant compressive pericardial mass composed of fibrinous material, with particular involvement of the right ventricle. Exclusion of other conditions, such as neoplasms and infections, is necessary.

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P187 Multimodality in tuberculous constrictive pericarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.057 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Leite De Barros Filho ◽

H T Moreira ◽

M K Santos ◽

A Schmidt ◽

R C Santana ◽

...

Keyword(s):

Constrictive Pericarditis ◽

Low Cost ◽

Vena Cava ◽

Left Ventricular ◽

Etiologic Agent ◽

Functional Evaluation ◽

Initial Image ◽

The Right ◽

Active Inflammation ◽

Pericardial Thickening

Abstract CASE PRESENTATION K.C.P., a 26 y.o. female, presenting dizziness and progressive dyspnea since 9 months ago. Physical examination showed hepatomegaly at 2 centimeters below the right inferior costal border, but without edema, cardiac murmurs or other findings. Electrocardiogram showed atria overload and diffuse ventricular repolarization abnormality. Chest X-ray revealed normal sized cardiac silhouette but with signs of pericardial calcification. Transthoracic echocardiogram revealed: enlargement of both atria, no signs of myocardial left ventricular (LV) hypertrophy; dilated inferior vena cava with minimal respiratory variation; septal bounce; septal e´= 17.20 cm/s, lateral e´= 6.09 cm/s; E/e" septal ratio = 3.9; E deceleration time = 144 ms; thickening and hyper-refringence of the pericardium with calcification adjacent to the lateral and inferior walls of the LV and the free wall of the right ventricle. For evaluation of thickness and extent of pericardial involvement, computed tomography (CT) was performed, showing gross calcifications of the pericardium, mainly in basal and lower portions, without pericardial effusion. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement revealed areas suggestive of active inflammation adjacent to the basal wall of the LV. With this evidence of active inflammatory activity, the patient was treated empirically against the etiologic agent for tuberculosis. Because of progressively severe edema and dyspnea pericardiectomy was warranted providing relief of symptoms. DISCUSSION: The echocardiogram is the initial image exam for diagnosis and monitoring of pericardial conditions. It is a widely available, low-cost method that does not use ionizing radiation and allows a complete morphological and functional evaluation of the heart. However, in up to 20% of cases, pericardial thickening may not be detectable at echocardiography. CT allows a more accurate assessment of pericardial thickening, while CMR allows detection of active inflammatory process. CONCLUSION: A typical and illustrative clinical case of constrictive pericarditis is presented, where the multimodality of cardiac imaging was decisive for the diagnostic and therapeutic delineation.

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Effusive–constrictive pericarditis in the spectrum of pericardial compressive syndromes

Heart ◽

10.1136/heartjnl-2020-316664 ◽

2021 ◽

Vol 107 (6) ◽

pp. 450-455

Author(s):

Scott E Janus ◽

Brian D Hoit

Keyword(s):

Constrictive Pericarditis ◽

Clinical Evidence ◽

Pericardial Fluid ◽

Right Atrial ◽

Pericardial Disease ◽

Non Invasive ◽

Prevalence Estimates ◽

Diagnostic Modalities ◽

The Right ◽

Effusive Constrictive Pericarditis

When pericardial fluid accumulates and exceed the reserve volume of the pericardium or when the pericardium becomes scarred and inelastic, one of three pericardial compressive syndromes may ensue, namely, cardiac tamponade (CT), characterised by the accumulation of pericardial fluid under pressure; constrictive pericarditis (CP), the result of scarring and loss of the normal elasticity of the pericardial sac; and effusive–constrictive pericarditis (ECP), characterised by the concurrence of a tense pericardial effusion and constriction of the heart by the visceral pericardium. Although relatively uncommon, prevalence estimates vary widely and depend on the nature of the cohorts studied, the methods used to diagnose ECP and the manner in which ECP is defined. Most cases of ECP are idiopathic, reflecting the frequency of idiopathic pericardial disease in general, and other causes include radiation, malignancy, chemotherapy, infection and postsurgical/iatrogenic pericardial disease. The diagnosis of ECP often becomes apparent when pericardiocentesis fails to decrease the right atrial pressure by 50% or to a level below 10 mm Hg. Important non-invasive diagnostic modalities include echocardiography, cardiac magnetic resonance and, to a lesser extent, cardiac CT. In cases with clear evidence of pericardial inflammation, a trial of an anti-inflammatory regimen is warranted. A complete pericardiectomy should be reserved for refractory symptoms or clinical evidence of chronic CP.

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Constrictive pericarditis

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198703341.003.0038 ◽

2015 ◽

pp. 520-535

Author(s):

Jérôme Garot ◽

Frank Rademakers

Keyword(s):

Differential Diagnosis ◽

Constrictive Pericarditis ◽

Clinical Findings ◽

Respiratory Cycle ◽

Atrial Pressure ◽

Pericardial Disease ◽

Multiple Modalities ◽

Pericardial Syndromes ◽

Very High ◽

Pericardial Thickening

The diagnosis of constrictive pericarditis (CP) generally requires both the demonstration of an appropriate physiology and evidence of pericardial thickening. Differential diagnosis in pericardial disease remains difficult and challenging to the clinician. The pathophysiologic characteristics of the various pericardial syndromes can be studied with different imaging modalities, but it is crucial to register morphology, function and flow during the different phases of the respiratory cycle. When a discrepancy exists between clinical findings and hemodynamic evaluation with imaging, multiple modalities should be combined and, if a very low or very high atrial pressure is suspected, an intervention to increase or lower this pressure can be required to unmask characteristic findings during respiration with respect to ventricular interdependence.

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A case report of tuberculous constrictive pericarditis necessitating total pericardiectomy

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab328 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Nooraldaem Yousif ◽

Abdulla Alnuwakhtha ◽

Abdulla Darwish ◽

Zaid Arekat ◽

Seham Abdulrahman

Keyword(s):

Constrictive Pericarditis ◽

Tuberculous Lymphadenitis ◽

Unique Case ◽

Non Invasive ◽

Case Summary ◽

Novel Approach ◽

Remarkable Recovery ◽

Diagnostic Modalities ◽

The Right ◽

Pericardial Thickening

Abstract Background Constrictive pericarditis (CP) is one of the most serious sequelae of tuberculous pericarditis, which is characterized by heart constriction secondary to intense pericardial inflammation and thickening. Several invasive and non-invasive diagnostic modalities are crucial to address the challenges of confirming the diagnosis of CP and to expedite timely intervention. Case summary This study reports the case of a Bahraini male with tuberculous lymphadenitis diagnosed with CP as a result of various evaluations. The patient underwent urgent total pericardiectomy and showed remarkable recovery with complete resolution of heart failure symptoms. Discussion This case demonstrates the paramount importance of early diagnosis and treatment for patients with CP. In this unique case, the acoustic windows on echocardiography were suboptimal because of pericardial thickening. Further, computed tomography did not show significant calcification of the thickened pericardium. A novel approach of assessing haemodynamics through the right antecubital vein and right radial artery facilitated the accurate diagnosis of CP with confidence. Thereafter, successful pericardiectomy revealed a markedly thickened and stiff pericardium with many abscesses and dense adhesions encasing the heart, and pericardial biopsy showed large caseating granulomas. This case exemplifies the difficulty in diagnosing CP and the favourable outcomes achieved with well-timed surgical intervention.

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Severe pulmonary regurgitation mimicking constrictive pericarditis: a case report—the sac or the content? That is the question

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa090 ◽

2020 ◽

Vol 4 (3) ◽

pp. 1-5

Author(s):

Makiko Suto ◽

Kensuke Matsumoto ◽

Hidekazu Tanaka ◽

Ken-Ichi Hirata

Keyword(s):

Constrictive Pericarditis ◽

Diastolic Pressure ◽

Pathological Condition ◽

Preoperative Evaluation ◽

Pulmonary Regurgitation ◽

Right Atrial ◽

Diagnostic Pitfall ◽

Physiological Limit ◽

The Right ◽

Pericardial Thickening

Abstract Background Constrictive pericarditis (CP) is a pathological condition of the pericardium, resulting from fibrosis, scarring, and calcification of the pericardium. Other conditions have been reported to mimic ‘constrictive physiology’ despite the presence of an intact pericardium. However, there has been no report of pulmonary regurgitation (PR) mimicking the haemodynamic characteristics of CP. Case summary A 51-year-old woman was admitted to our institute because of severe right-sided heart failure. Transthoracic echocardiography revealed severe PR concomitant with significant dilatation of the right-sided heart. Septal bounce and the respiratory reciprocation of the transmitral and transtricuspid inflow velocities were also observed, indicating exacerbated ventricular interdependence. Cardiac catheter examination demonstrated elevated right atrial pressure with a prominent y descent, dip, and plateau waveform in the right ventricular pressure, and equalization of the diastolic pressure of all cardiac chambers, which are quite consistent with CP. On surgical inspection, however, there was no pericardial thickening or adhesion, indicating no obvious signs of CP. Discussion Pericardial constriction results from the relative relationship between intrapericardial volume and pericardial reserve. When the intrapericardial volume exceeds the physiological limit, the cardiac chambers compete with each other in a fixed pericardial space. In this case, prominent dilation of the right-sided chambers caused by severe PR resulted in overstretching of the pericardium above the pericardial reserve, which led to a characteristic haemodynamic picture that resembled CP. Thus, it is important to recognize the diagnostic pitfall in the preoperative evaluation of a ‘CP mimic physiology’.

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Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge

The Heart Surgery Forum ◽

10.1532/hsf98.2013251 ◽

2014 ◽

Vol 17 (1) ◽

pp. 42

Author(s):

Shi-Min Yuan

Keyword(s):

Computed Tomography ◽

Liver Cirrhosis ◽

Female Patient ◽

Constrictive Pericarditis ◽

Delayed Diagnosis ◽

Young Female ◽

Refractory Ascites ◽

Diagnostic Challenge ◽

Massive Ascites ◽

History Of

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

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A rare variation in the formation of the lower trunk of the brachial plexus its embryological basis and clinical importance - a case report

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v6i4.6727 ◽

2012 ◽

Vol 6 (4) ◽

pp. 49-52

Author(s):

N Satyanarayana ◽

R Guha ◽

P Sunitha ◽

GN Reddy ◽

G Praveen ◽

...

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Upper Limb ◽

Clinical Importance ◽

Medical Sciences ◽

Nerve Roots ◽

Rare Variation ◽

Lower Trunk ◽

Male Cadaver ◽

The Right

Brachial plexus is the plexus of nerves, that supplies the upper limb.Variations in the branches of brachial plexus are common but variations in the roots and trunks are very rare. Here, we report one of the such rare variations in the formations of the lower trunk of the brachial plexus in the right upper limb of a male cadaver. In the present case the lower trunk was formed by the union of ventral rami of C7,C8 and T1 nerve roots. The middle trunk was absent. Upper trunk formation was normal. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 49-52 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6727

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Journal selection behavior among early-career academicians in Iran: how they choose the most appropriate journal for their publications

Global Knowledge Memory and Communication ◽

10.1108/gkmc-09-2021-0146 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Amrollah Shamsi ◽

Brady D_ Lund ◽

Shohreh SeyyedHosseini ◽

Reza BasirianJahromi

Keyword(s):

Early Career ◽

Medical Sciences ◽

Online Questionnaire ◽

Scholarly Journals ◽

Content Type ◽

Academic Promotion ◽

Promotion Policies ◽

Medical Researchers ◽

Selection Behavior ◽

The Right

Purpose Journals are the essential tools of researchers, especially academicians, to present their scientific findings. So, choosing the right journal helps not only science development but also their academic promotion. The purpose of this study is to examine the factors that Iranian medical researchers consider when selecting scholarly journals in which to submit their work. Design/methodology/approach A self-administered online questionnaire was emailed in May 2021, with 101 responses received. The sample included all the faculty members with the role of “lecturer” in Iranian medical universities and who have 1–5 articles in the Scopus database as early-career Iranian medical researchers. The questionnaire consisted of 36 items, divided into five sections: basic information, attitudes and beliefs, ways to choose a journal, problems and familiarity with the components of scientometrics/validity metrics related to journals. Findings The findings indicate that these researchers value the expertise of experienced researchers and professionals, like librarians, when selecting publication venues. They often use journal indexes to guide journal selection. They also consider factors like the length of typical peer review and the complexity of submission guidelines when making decisions. Research limitations/implications The study of one country, though detecting requirements of journal selection behavior, cannot be generalized to the entire region. Practical implications The current study has academic implications as far as decisions on journal selection are concerned. University policymakers in Iran may consider re-examining their emphasis on academicians’ promotion policies at Iranian universities of medical sciences. Originality/value These findings may support the work of early-career researchers and those individuals (e.g., librarians) that serve them, as well as publishers and editors of scholarly journals.

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