Constrictive Pericarditis: A Diagnostic Conundrum

A 65-year-old male presented with chest pain, tachycardia, tachypnea, and diminished breath sounds. His lab investigations revealed an elevated leukocyte count, erythrocyte sedimentation rate, and B-type natriuretic peptide. Transthoracic echocardiography and chest imaging revealed the presence of pericardial effusion without tamponade and he was treated for presumed acute idiopathic pericarditis. He was started on indomethacin and colchicine but he stopped them prematurely due to side effects. Subsequently, he developed pleural effusions and ascites requiring multiple thoracenteses and paracenteses. Due to equivocal echocardiographic findings, he underwent invasive hemodynamic measurements which demonstrated equalization of filling pressures and ventricular interdependence, confirming constrictive pericarditis. Due to ongoing pericardial inflammation on cardiovascular magnetic resonance imaging, he was treated with a prednisone taper. Due to persistent symptoms and fibrosis of the pericardium on cross-section imaging, he underwent pericardiectomy. He did well with the procedure and has had an uneventful clinical follow-up.

Automated summary

A 65-year-old male presented with symptoms of chest pain, tachycardia, tachypnea, and diminished breath sounds. Lab investigations showed elevated levels of leukocyte count, erythrocyte sedimentation rate, and B-type natriuretic peptide. Imaging revealed pericardial effusion without tamponade, and the patient was initially treated for acute idiopathic pericarditis. However, subsequent developments of pleural effusions and ascites led to the diagnosis of constrictive pericarditis. The patient underwent pericardiectomy and had a successful recovery.