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Atypical Chest X-Ray Calcification in an Idiopathic Constrictive Pericarditis Case

DOI: 10.1155/2013/609610

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Constrictive pericarditis is an uncommon cause of heart failure. It is a clinical entity caused by thickening, fibrosis, and/or calcification of the pericardium. We present a 50-year-old female patient who was admitted to our institution with a 6-month history of progressive dyspnea on exertion, abdominal swelling, and lower extremity edema. Her chest X-ray revealed an oblique linear calcification in the cardiac silhouette. Transthoracic echocardiography revealed biatrial enlargement. Left ventricular size and systolic function were normal. Cardiac computed tomography revealed the pericardial thickening (>5?mm) and heavy calcification in left atrioventricular groove. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip, and plateau. Pericardiectomy was performed which revealed a thick, fibrous, calcified, and densely adherent pericardium constricting the heart. The postoperative period was uneventful and was in NYHA functional class I after 3 months. 1. Introduction Constrictive pericarditis (CP) is uncommon cause of heart failure. It is a clinical entity caused by thickening, fibrosis, and/or calcification of the pericardium. This entity often leads to impairment of diastolic filling, resulting predominantly in symptoms of right heart failure [1]. Currently, idiopathic or viral pericarditis is the predominant cause in the industrialized countries, followed by cardiac surgery and mediastinal irradiation, which are as well the major and increasing causes of CP in the industrialized countries [2–4]. Tuberculosis is still a common cause of CP in developing and underdeveloped countries, as well as in the immunosuppressed patients [5]. Modern series from Saudi Arabia, Mexico, Turkey, and India document tuberculosis in 38% to 83% of all cases of CP. Pericardial disease rarely presents as the initial manifestation of tuberculosis [6–9]. Although pericardial calcification on chest X-ray suggests constriction, it is not diagnostic but may lead to more detailed investigations. A pericardial thickness less than 2?mm is normal and greater than 6?mm in size is specific for constriction [10]. Cardiac CT and MRI can detect pericardial thickening and calcification with high accuracy [11]. Echocardiography and new Doppler techniques are very useful for differential diagnosis between CP and restrictive cardiomyopathy [12, 13]. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high in end

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