Constrictive pericarditis with pseudocirrhosis secondary to compression of right cardiac chambers by huge calcific pericardial cystic mass

摘要

A 73-year-old male patient was admitted to our cardiology department with complaints of exertional dyspnea and abdominal distention of 6 months' duration. He had complained of fatigue and shortness of breath, which corresponded to New York Heart Association class III symptoms, so his physician had put him on oral diuretics. On physical examination, his heart rate was 93 bpm. The liver was enlarged and palpable 10 cm below the right costal margin. Muffled heart sounds without murmur, venous dilatation of the extremities, neck vein distension, hepatojugu-lar reflux, and abdominal ascites were detected. Chest x-ray showed bilateral pleural effusion but did not demonstrate a hyperdense calcific mass (Figure 1). Transthoracic echocar-diography showed unclear but detected compression of right cardiac chambers, dilated inferior vena cava with reduced inspiratory collapse, mild tricuspid valve regurgitation, and an estimated right ventricular systolic pressure of 46 mmHg, whereas the left heart system was normal. Computed tomography (Figure 2) and transesophageal echocardiography (Figure 3 and Movie I in the online-only Data Supplement) displayed a 48x46x38-mm high-density area, a cystic lesion located in the anterior mediastinum adjacent to the right cardiac chambers, and bilateral pleural effusion.