A case report of constrictive pericarditis: a forgotten cause of refractory ascites

Abstract

Constrictive pericarditis is well known but rare and commonly forgotten cause of ascites. Early diagnosis of constrictive pericarditis is difficult due to absence of typical cardiopulmonary signs and multiple vague symptoms and its insidious course. In this case report, we present , a 61-year-old male referred for liver transplantation vs transjugular intrahepatic portosystemic shunt work-up for presumptive diagnosis of nonalcoholic steatohepatitis cirrhosis and refractory ascites. Comprehensive work-up before liver transplantation including liver biopsy, liver ultrasound, and Doppler, magnetic resonance imaging was not consistent with liver cirrhosis. Echocardiographic was suggestive of constrictive pericarditis, further work-up with right heart catheterization, cardiovascular magnetic resonance and multidetector cardiac computed tomography confirmed the diagnosis of constrictive pericarditis. Patient underwent surgical pericardiectomy, he reminded stable after surgery and did not require further paracentesis and discharged in stable condition.

A Case Report of Constrictive Pericarditis: Step by Step Surgical Treatment of the Disease, Complications and Long-Term Outcomes

“…Timely fixing severe tricuspid valve regurgitation prevents progressing heart failure and right ventricular dilation in the postoperative period; however, has no statistically significant effect on the death rate in the long run [7].…”

Case Report: Unexplained ascites can be constrictive pericarditis

“…For diagnostic certainty to confirm the diagnosis and begin the final course of therapy, the complementary roles of multidetector computed tomography (MDCT) and cardiac MRI are frequently useful. 11 The patient's symptoms were relived after pericardiectomy and treatment with antitubercular drugs and the parents of the patient were satisfied with treatment received.…”

“…Consideration of it as a differential diagnosis, careful history taking, and a thorough physical examination are the most crucial components of the diagnosis. 5 In India, there are few prospective studies that have assessed the particular risk in the context of various etiologies of constrictive pericarditis. 4 This patient commonly presents with chest pain, breathlessness, pedal edema, narrow pulse pressure, pulse paradoxes, increased JVP, hepatomegaly, ascites, pericardial frictional rub and muffled heart sound.…”

The Utility of Invasive Hemodynamic Assessment in Diagnosing Constrictive Pericarditis: A Case Report

“…Physical examination findings of lower extremity edema and enlargement of the liver are found in more than 50% of cases [ 4 ]. Ascites from liver disease in CP are frequently reported and are often misjudged as nonalcoholic steatohepatitis as a cause of cirrhosis [ 5 ]. Jugular venous pressure (JVP) elevation remains the most important finding as it is typically not found in chronic cases of liver dysfunction.…”