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Recurrent pleural effusions, resistant atrial arrhythmias, and abnormal liver function tests: general medicine or cardiology?

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N Melikian, J Anderson*, D Lefroy, Departments of Cardiology and Cardiothoracic Surgery*, Hammersmith Hospital, London, UK Correspondence to: Dr N Melikian; drnarbeh{at}

A 65 year old man presented with recurrent pleural effusions. Repeated pleural fluid examination and pleural biopsy were unremarkable. Pericardial calcification was noted on admission and attributed to an uncomplicated episode of pericarditis 30 years previously. His symptoms and signs were not thought not to be associated with the heart. While awaiting an open pleural biopsy the patient was admitted with a further pleural effusion, jaundice, resistant atrial arrhythmias, and dyspnoea. Hepatic investigations including autoantibody screen and transjugular liver biopsy were normal.

The significance of these signs and symptoms, the diagnosis, and the management of these problems are discussed in an interactive case presentation.

The purpose of this interactive case presentation is to illustrate:

  • The common causes of pericardial effusions

  • How to diagnose patients with pericardial constriction

  • The value of various diagnostic investigations for pericardial constriction

  • The differential diagnosis of pericardial constriction

This interactive case history is hosted on BMJ Learning—the best available learning website for medical professionals from The BMJ Group.

To access the interactive case, please use [Take this module on BMJ Learning] link from the online article content box or table of contents.


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