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 1099 Constrictive pericarditis:a challenge in Cardiology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Kairis ◽  
C Stefanidis ◽  
B Saxpekidis ◽  
C Petridis ◽  
L Mosialos ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pulmonary Artery ◽  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Cardiac Catheterization ◽  
Constrictive Pericarditis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Permanent Pacemaker ◽  
Right Heart

Abstract Funding Acknowledgements none A 50-year old woman had complained about dyspnea and leg swelling despite taking furosemide 80 mgr per day. Her past medical history had included radiation therapy for Hodgkin"s lymphoma, prosthetic heart valves (mechanical MV, AV- INR = 3,2) and permanent pacemaker. Also her coronary vessels were normal. On clinical examination she was non-febrile, the arterial pressure was 120/80mmHg,there was atrial fibrillation at 70 pulses/min at rest and oxygen saturation was 96%. The chest x-ray finding was left pleural effusion. The patient also had ascites. Kidney function was normal without proteinuria. The diagnostic paracentesis and biochemical analysis of ascitic fluid was indicative of transudative fluid.Cytologic analysis was negative for malignancy. Moreover,needle biopsy specimen was subjected to histopathology,which was negative for malignancy. Echocardiography had revealed normal size and function of left ventricle ( LV = 46mm-EF = 60%). The mechanical valves had normal function, without paravalvular leak or masses. Also right ventricle was normal. The pulmonary artery pressure measured by echocardiography was in the normal range (RVSP = 35mmHg), but the inferior vena cava was dilated.There were also dilated hepatic veins and hepatic vein flow reversal.There was variation> 25% in triscupid inflow with respiration. TEE had confirmed the findings of transthoracic echo with regard of prosthetic valves. CT of chest and abdomen findings were no pathologic lymphadenopathy,no pulmonary embolism and absence of tumor compressing inferior vena cava. Chest CT scan had demonstrated pericardium thickening,indicative of constrictive pericarditis. CMR was not performed because of permanent pacemaker. The final step in diagnostic algorithm was cardiac catheterization: a)the pulmonary artery systolic pressure measured during right heart catheterization was 35mmHg. b)dip & plateau’ pattern or ‘square root sign of right ventricle, i.e. pattern of accentuated early dip in diastolic pressure, followed by plateauing in mid-late diastole. c)prominent y wave of right atrium- absent x wave because of AF. d)left ventriculography was not performed because of mechanical aortic valve. At the end constrictive pericarditis was confirmed by the surgical report. According to ESC guidelines a diagnosis of constrictive pericarditis is based on the association of signs and symptoms of right heart failure and impaired diastolic filling due to pericardial constriction by one or more imaging methods, including echocardiography, CT, CMR, and cardiac catheterization. However,the most important step is the suspicion of constrictive pericarditis, especially in patients with history of radiation therapy and heart surgery. Abstract 1099 Figure.

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.

Abstract 1759: A 27 year-old Man from ’the Valley’ with Shortness of Breath

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jennifer E Ho ◽  
Yerem Yeghiazarians
Keyword(s):  
Lower Extremity ◽  
Cardiac Catheterization ◽  
Constrictive Pericarditis ◽  
Venous Pressure ◽  
Restrictive Cardiomyopathy ◽  
Left Ventricular ◽  
Shortness Of Breath ◽  
Significant Past Medical History ◽  
Valley Fever ◽  
Mitral Inflow

A 27 year-old man with no significant past medical history was admitted with shortness of breath and subjective fevers. He was diagnosed with Valley fever based on pulmonary infiltrates on chest x-ray and elevated Coccidiomycosis immitis IgG and IgM titers and was treated with antifungal therapy. He subsequently developed worsening dyspnea, orthopnea, and lower extremity swelling. On exam his jugular venous pressure was elevated and he had bilateral pleural effusions, lower extremity edema, and a positive Kussmaul sign. The electrocardiogram showed sinus tachycardia with diffuse T-wave inversions. Echocardiography demonstrated thickened adhesive pericardium, exaggerated respirophasic variation of the tricuspid and mitral inflow Doppler patterns and a prominent septal bounce. Cardiac MRI showed markedly thickened enhancing pericardium with an associated small pericardial effusion and prominent septal bounce. There was no delayed enhancement to suggest myocarditis. Cardiac catheterization showed equalization of diastolic pressures in all four chambers, low cardiac output, and simultaneous right and left ventricular pressures showed respirophasic discordance suggestive of increased ventricular interdependence. All of the above findings were consistent with constrictive pericarditis in the setting of disseminated coccidioidomycosis, and the patient underwent urgent surgical pericardiectomy with improvement in his symptoms. Pathology specimens demonstrated fungal spherules and active inflammation consistent with Coccidiomycosis immitis infection of the pericardium. This case illustrates the multi-disciplinary diagnostic approach that is often needed to distinguish constrictive pericarditis from restrictive cardiomyopathy. It highlights classic features of constrictive physiology seen on imaging and cardiac catheterization in a unique case of fungal pericarditis. Pericardial involvement in disseminated coccidioidomycosis is rare, and constrictive pericarditis treated with pericardiectomy has been described in only two prior cases in the literature.

scholarly journals 544 Two cases of constrictive pericarditis temporally associated with mRNA-1273 COVID-19 vaccination

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Davide Diana ◽  
Ilaria Cardillo ◽  
Vincenzo Polizzi ◽  
Francesco Musumeci
Keyword(s):  
Pericardial Effusion ◽  
Ct Scan ◽  
Constrictive Pericarditis ◽  
Systolic Function ◽  
Vena Cava ◽  
Acute Pericarditis ◽  
Post Marketing Surveillance ◽  
Post Marketing ◽  
History Of ◽  
Ecg Abnormalities

Abstract Aims The SARS-CoV-2 pandemic has led to the development of the mRNA vaccines in humans which are well tolerated, safe, and highly efficacious; however, post-marketing surveillance is revealing potential rare cardiac adverse effects as acute pericarditis. We herein report two cases of symptomatic constrictive pericarditis following administration of the second dose of mRNA-1273 (Moderna) SARS-CoV-2 vaccine. Methods and results Case summary: A 75 years old male with history of hypertension and COPD presented to our Hospital approximately one month after the second dose of mRNA-1273 SARS-CoV-2 Vaccine with dyspnoea and leg oedema. Routine analysis resulted normal, no increasing of inflammatory markers or ECG abnormalities. Echocardiogram showed circumferential fibrinous pericardial effusion without tamponade and typical features of constrictive pericarditis: annulus reversus, ventricular interdependence, expiratory diastolic flow reversal in hepatic vein, inferior vena cava plethora. Pleural ultrasound showed bilateral pleural effusion that was sampled and showed a transudate fluid. Tumoral marker and a CT Scan, autoimmunity panel, blood tests for bacteraemia and Quantiferon were negative. Cardiac magnetic resonance imaging confirmed thickening of pericardium. A 68 years old male with history of ischaemic heart disease with previous CABG, hypertension, dyslipidaemia and chronic kidney disease presented with palpitations and mild legs swelling. Approximately, 2 months before he received the second dose of mRNA-1273 SARS-CoV-2 vaccine. Routine blood examinations resulted normal, ECG showed a right bundle branch block. Echocardiogram showed a mild enlargement of LV with normal systolic function, a moderate primary mitral regurgitation and a circumferential pericardial effusion, showing signs of constrictive syndrome. CT Scan demonstrated pericardium thickness. Constrictive pericarditis may represent a subacute complication of an asymptomatic exudative acute pericarditis. Although cases of acute pericarditis have been reported after SARS-CoV-2 vaccine, to our knowledge, the association with constrictive pericarditis has not been described. The temporal link between vaccination and symptoms development as the biological plausibility of autoimmune or cross-reaction response to vaccination in predisposed subjects could suggest a possible correlation as an adverse event, even if causality could not be established. Conclusions We present two cases of constrictive pericarditis occurring after mRNA-1273 SARS-CoV-2 vaccination, aiming further data to confirm a causal role.

Abstract 5932: The Differences of Echocardiography and MRI Findings in Patients with Constrictive Pericarditis According to the History of Chest Radiation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kye Hun Kim ◽  
DaLi Feng ◽  
James Glockner ◽  
Matthew Martinez ◽  
William D Edwards ◽  
...  
Keyword(s):  
Constrictive Pericarditis ◽  
Left Ventricular ◽  
Volume Index ◽  
Significant Finding ◽  
Mri Findings ◽  
Mitral Inflow ◽  
Myocardial Disease ◽  
Group I ◽  
History Of ◽  
Group Ii

Background: Radiation therapy (RT) to the chest may induce various combined cardiac problems such as constrictive pericarditis (CP), restrictive myocardial disease, and coronary artery disease. Therefore, it was hypothesized that the MRI and transthoracic echocardiographic (TTE) findings in patients with CP may differ according to the history of RT. Methods: A total of 68 patients with CP who performed both TTE and MRI study at Mayo Clinic from 2002 to 2008 were reviewed and divided into two groups according to the history of RT; RT group (group I, n=13, 53.6±9.8 years, 8 males) versus no RT group (group II, n=55, 59.0±14.8, 45 males). Results: The results of TTE study were summarized in table . Early diastolic velocity of septal mitral annulus (E′) and deceleration time (DT) of mitral inflow was significantly lower, and the ratio of early diastolic mitral inflow velocity (E) to E′ is significantly higher in group I than in group II. Left atrial volume index (LAVI) was significantly lower and LA area and left ventricular end-diastolic dimension (LVEDD) was significantly smaller in group I than in group II. Delayed enhancement of pericardium was the only significant finding in MRI and significantly prevalent in group I than in group II (100.0% in group I vs 63.6% in group II, p=0.012). The other MRI findings including pericardial thickness, left ventricular and right ventricular ejection fraction, and the presence of pericardial and pleural effusion were not different between the groups. Conclusion: In CP patients with the history of RT compared to patients without history of RT, E′ and DT was significantly lower, LAVI and LVEDD were smaller, pericardial DE in MRI was invariably found. The lower E′ velocity and decreased chamber size and volumes may be explained by RT induced coexisting myocardial disease. TTE findings of the patients

Budd-Chiari syndrome due to segmental obstruction of the inferior vena cava successfully managed with endovascular stenting

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 22-26
Author(s):  
Uyen Vo ◽  
Duc Quach ◽  
Luan Dang ◽  
Thao Luu ◽  
Luan Nguyen
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Laboratory Data ◽  
Transaminase Level ◽  
Vena Cava ◽  
Budd Chiari Syndrome ◽  
Endovascular Stenting ◽  
Massive Ascites ◽  
Chiari Syndrome ◽  
History Of

Budd–Chiari syndrome (BCS), a rare and life-threatening disorder due to hepatic venous outflow obstruction, is occasionally associated with hypoproteinemia. We herein report the first case of BCS with segmental obstruction of the intrahepatic portion of inferior vena cava (IVC) and hepatic veins (HVs) successfully treated by endovascular stenting in Vietnam. A 32-year-old female patient presented with a 2-month history of massive ascites and leg swelling. She refused history of oral contraceptives use. Hepatosplenomegaly without tenderness was noted. Laboratory data showed polycythemia, mild hypoalbuminemia and hypoproteinemia, slightly high total bilirubin and normal transaminase level. The serum ascites albumin gradient was 1.9 g/dL and ascitic protein level was 1.1 g/dL. The other data were normal. BCS was suspected because of the discrepancy between mild liver failure and massive ascites; and the presence of hepatosplenomegaly and polycythemia. On abdominal magnetic resonance imaging, the segmental obstruction of three HVs and IVC was 2-3 cm long without thrombus. Cavogram revealed the severe segmental stenosis of intrahepatic portion of IVC with no visualized HV and extensive collateral veins. A Protégé stent was deployed to IVC. Leg swelling and ascites were completely resolved within 3 days after stenting. During 1-year follow-up, edema was not recurred and repeated laboratory results were all normal.

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

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.

THERAPEUTIC MANAGEMENT OF ASCITES IN SPITZ DOG IN BANGLADESH WITH A BRIEF REVIEW ON CANINE ASCITES

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
M. A. Samad
Keyword(s):  
Ascitic Fluid ◽  
Clinical Examination ◽  
Clinical Case ◽  
Abdominal Distension ◽  
Multiple Organ ◽  
Therapeutic Management ◽  
Vitamin Supplement ◽  
Case Record ◽  
Successful Recovery ◽  
History Of

Background: Ascites is one of the most important clinical syndromes, caused by multiple organ disorders, characterized by abdominal distension with accumulation of fluid of various colors and consistencies depending on the etiology that are encountered commonly in canine practice worldwide. Although it has been reported from different countries including India but it has not yet been documented from Bangladesh. Objectives: To evaluate the successful therapeutic management of a clinical case of ascites in dog supported with its brief review for its appropriate application Materials and Methods: A female Spitz dog two and half years old brought for treatment with the history of abdominal distension on 1st November 2009. Clinical examination, abdominocentesis and laboratory examination of ascitic fluid were used for the diagnosis of ascites in dog. Results: Clinical examination revealed dyspnea, discomfort, lethargy, weakness, pale mucous membrane, normal rectal temperature 103.2 0F and distended abdomen with fluid thrill on palpation. Examination of ascitic fluid revealed clear white fluid (pure transudate) which is mainly hepatic origin resulting portal hypertension and hypoproteinaemia. Treatment with restricted sodium diet, antibiotic (amoxicillin), diuretic (furosemide; Lasix, Sanofi Aventis) and vitamin B-complex and C- vitamin supplement with regular monitoring assisted in successful recovery. The recovered dog survived for next five years up to 2014 and then died due to other reasons. Conclusions: This clinical case record on canine ascites with successful treatment along with review especially on the methods of diagnosis and cause-wise treatment would certainly help the clinician for proper management of the clinical cases of canine ascites. Keywords: Ascites, Spitz dog, Diagnosis, SAAG, Therapeutic management, Brief review

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