Pericardial calcification in constrictive pericarditis
1 Department of Neurology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN, 55905, USA
2 Division of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
International Journal of Emergency Medicine 2012, 5:37 doi:10.1186/1865-1380-5-37Published: 13 October 2012
A high index of suspicion is required to make the diagnosis of constrictive pericarditis (CP) in patients presenting with cirrhosis and volume overload, as they can otherwise go misdiagnosed for years.
A 51 year-old man with a history of presumed alcoholic cirrhosis presented to the emergency department with anasarca. Abdominal ultrasound with Doppler demonstrated a nodular cirrhotic liver, but no evidence of portal hypertension or ascites. The chest x-ray, however, was significant for a right-sided pleural effusion and pericardial calcification, suggestive of (CP). Transthoracic echocardiogram and ECG-gated computerized tomography scan of the chest without IV contrast confirmed the diagnosis. The patient was referred to thoracic surgery for definitive pericardiectomy.
The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. Although a multimodality approach is necessary for the diagnosis of CP, this case highlights the utility of chest x-ray, a relatively non-invasive and inexpensive test, in expediting the diagnosis.