Medical Image of the Week: Constrictive Pericarditis

Wednesday, May 7, 2014 at 8:00AM
Rick Robbins, M.D. in CT scan, cardiac catherization, constrictive pericarditis, elevated end diastolic pressure, end diastolic pressure, equalization of diastolic pressures, pericardectomy, pericardial calcification, respiratory failure, thoracic CT scan

Figure 1. A computerized tomography of the chest revealed cardiomegaly, bilateral pleural effusions and pericardial calcification noted diffusely with focal regions of pericardial thickening greater than 4 mm.

A 62-year-old woman, with a past medical history significant for oxygen dependent COPD, paroxysmal atrial fibrillation, and obstructive sleep apnea, presented to the hospital with hypoxemic respiratory failure requiring intubation and mechanical ventilation. A computerized tomography of the chest revealed cardiomegaly, bilateral pleural effusions, and pericardial calcification that was noted diffusely with focal regions of pericardial thickening greater than 4 mm. A cardiac catheterization revealed elevated right-sided pressure; markedly elevated left ventricular end diastolic pressure; equalization of LV-RV diastolic pressures; and sharp Y descent on the right atrial pressure waveform; which is all suggestive of constrictive physiology.  The patient was medically optimized and diuresed and eventually underwent a successful pericardiectomy.

Mohammed Alzoubaidi MD, John Bloom MD, Jarrod Mosier MD, Linda Snyder MD

Department of Pulmonary and Critical Care Medicine, University of Arizona,

Tucson, AZ

Reference as: Alzoubaidi M, Bloom J, Mosier J, Snyder L. Medical image of the week: constrictive pericaditis. Southwest J Pulm Crit Care. 2014;8(5):280. doi: http://dx.doi.org/10.13175/swjpcc042-14 PDF

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).