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A PICTURE IS WORTH A THOUSAND WORDS
Year : 2011  |  Volume : 12  |  Issue : 1  |  Page : 40-41  

Tubercular chronic calcific constrictive pericarditis


Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Date of Web Publication25-May-2011

Correspondence Address:
Pravin K Goel
Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1995-705X.81549

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How to cite this article:
Goel PK, Moorthy N. Tubercular chronic calcific constrictive pericarditis. Heart Views 2011;12:40-1

How to cite this URL:
Goel PK, Moorthy N. Tubercular chronic calcific constrictive pericarditis. Heart Views [serial online] 2011 [cited 2019 Dec 15];12:40-1. Available from: http://www.heartviews.org/text.asp?2011/12/1/40/81549

A30-year-old gentleman presented with a history of progressive dyspnoea with distension of abdomen, pedal edema and loss of weight of 1 month duration. Clinical examination revealed raised jugular venous pressure with rapid y descent and Kussmaul's sign. ECG showed low-voltage complexes. Chest X-ray [Figure 1]a and b showed normal cardiac size with calcification of the pericardium. 2D echocardiography was suggestive of chronic constrictive pericarditis. Computed tomography of the thorax showed heavy egg shell calcification of the pericardium mimicking snow fall on mountain appearance [Figure 2]a and b, [Figure 3]a and b. Patient underwent successful pericardiectomy with dramatic improvement in dyspnoea, ascites, and pedal edema. Computed tomography is the gold standard imaging tool for cardiac calcification especially involving the pericardium.
Figure 1: a) Chest X-ray, PA view and b) lateral view, show pericardial calcification along anterior and interior borders

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Figure 2: a) Computed tomography, sagittal view and b) coronal view show egg-shell calcification of the pericardium

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Figure 3: a) AP View, b) lateral view. Computed tomographic volume rendered image showing dense egg-shell calcification of the pericardial mimicking "snow fall on mountain" appearance

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   Discussion Top


Pericardial calcification is a common finding in patients with constrictive pericarditis. Careful examination of chest X-ray may raise the suspicion of calcific constrictive pericarditis. Standard chest CT-scan allows a nice anatomic delineation of the pericardium and its calcifications. Furthermore, computed tomography best defines the often asymmetric degree of pericardial thickening or calcification, which may be important in determining the optimal surgical approach for pericardial resection. [1] It is often associated with idiopathic disease and other markers of disease chronicity and is an independent predictor of increased perioperative mortality rates. [2] However the definitive diagnosis relies on a careful hemodynamic evaluation by right and left heart catheterization including respiratory recordings of RV and LV pressure changes. [3]

 
   References Top

1.Reinmüller R, Gürgan M, Erdmann E, Kemkes BM, Kreutzer E, Weinhold C. CT and MR evaluation of pericardial constriction: A new diagnostic and therapeutic concept. J Thorac Imaging 1993; 8:108-21.  Back to cited text no. 1
    
2.Ling LH, Oh JK, Breen JF, Schaff HV, Danielson GK, Mahoney DW, et al. Calcific constrictive pericarditis: Is it still with us? Ann Intern Med 2000; 132:444-50.  Back to cited text no. 2
    
3.Talraja DR, Nishimura RA, Holmes DR. Constrictive pericarditis in the modern era novel criteria for diagnostis in the cardiac catheterization laboratory. J Am Coll Cardiol 2007; 51:315-9.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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