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A 51 year old man presented with progressive worsening of chronic ascites. He had a history of chronic pericarditis of unknown cause requiring pericardiocentesis three timed in the last decade; the last performed six years previously.
At admission, physical examination revealed signs of systemic venous congestion, hepatomegaly, and a voluminous ascites with umbilical hernia. Spiral computed tomography of the heart after intravenous injection of contrast medium showed a mild amount of pericardial fluid, diffuse thickening, and calcification of visceral pericardium (epicardium), and only focal calcifications of parietal pericardium (the white arrows outline the thickened and calcified visceral pericardium; PE, pericardial effusion; F, epicardial fat; RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle).
Right cardiac catheterisation was consistent with constrictive pericarditis. The definite diagnosis was chronic effusive–constrictive pericarditis. This condition is characterised by the coexistence of epicardial constriction and pericardial effusion. Pericardial fluid may cause cardiac tamponade in which case pericardiocentesis results in only partial and temporary relief.
Effusive–constrictive pericarditis appears to begin as an active effusive pericarditis, with epicardial fibrosis and calcification developing later as a complication of the healing process. Reported causes do not seem to differ from those of non-effusive forms; the only exception being postsurgical constrictive pericarditis, which usually develops without effusion. Our patient had successful surgical removal of an extensively calcified epicardial layer.
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