Diagnosis and treatment of effusive–constrictive pericarditis: a case report

Al-Saiegh, Yousif; Spears, Jenna; Barry, Tim; Lee, Christopher; Haber, Howard L.; Goldberg, Sheldon

doi:10.1093/ehjcr/ytab174

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…Pericardiectomy is reserved for patients refractory to adequate anti-inflammatory therapy. Unfortunately, it has been reported that up to 16% of patients may continue to have symptoms, eventually requiring extensive pericardiectomy [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…It may also be diagnosed by utilizing T2-weighted cardiac MRI, which can delineate the pericardial thickening further and distinguish between edema, inflammation, and fibrosis. ECP may also help diagnose concomitant myocarditis by demonstrating typical features including myocardial injury (hyperemia, necrosis, scarring) in T1-weighted and myocardial edema in T2-weighted imaging [13][14][15]. ECP post-pericardiocentesis usually resolves either spontaneously or with medical management using NSAIDs, colchicine, or steroids for pain and inflammation.…”

Section: Discussionmentioning

confidence: 99%

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Surviving the Storm: Cardiac Tamponade and Effusive Constrictive Pericarditis Complicated by Pericardial Decompression Syndrome Induced by COVID-19 Infection in the Setting of Newly Diagnosed Acute Myeloid Leukemia (AML)

Abouzeid,

Mirza,

Bellafiore

et al. 2024

Cureus

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Coronavirus disease 2019 (COVID-19)-induced pericarditis and pericardial myocarditis are common entities; however, the development of pericardial effusion post-COVID-19 infection has only been reported in about 5% of cases. Rapid and acute progression to pericardial tamponade is uncommon, and progression to effusive constrictive pericarditis (ECP) and pericardial decompression syndrome (PDS) is an even rarer phenomenon. We describe these phenomena in this report to raise awareness and aid clinicians in the early diagnosis and management of these conditions. We report a case of a 45-year-old female with a past medical history of recent COVID-19 infection, uncontrolled diabetes mellitus, and hypertension who presented with severe chest pain, which was determined to be acute pericarditis post-COVID-19 infection. The patient developed a large pericardial effusion leading to cardiac tamponade within one day of initial presentation. Urgent pericardiocentesis was performed but was complicated by rapid decompensation of the patient, which has been assumed to be ECP following pericardiocentesis and PDS. Close monitoring of acute pericarditis with pericardial effusion is required in these patients for the early detection of cardiac tamponade, which requires urgent pericardiocentesis. Judicious post-pericardiocentesis follow-up is also required for the early diagnosis of conditions such as ECP and PDS. These cases are generally managed symptomatically, but in cases of severe ECP syndrome, pericardial stripping may be required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surviving the Storm: Cardiac Tamponade and Effusive Constrictive Pericarditis Complicated by Pericardial Decompression Syndrome Induced by COVID-19 Infection in the Setting of Newly Diagnosed Acute Myeloid Leukemia (AML)

Abouzeid,

Mirza,

Bellafiore

et al. 2024

Cureus

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“…ECP is a rare pericardial disease characterized by the coexistence of pericardial constriction and effusion. Its characteristic feature is a persistently elevated right atrial pressure of > 10 mmHg or a reduction of less than 50% from baseline despite pericardiocentesis[ 3 ]. The etiology of ECP varies, including idiopathic origin, viral origin, post-procedural origin, radiation, drug-induced, connective tissue disease, malignancy, and tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

“…The present case of ECP associated with P. aeruginosa infection demonstrated that in patients with localized pericardial effusion who have typical risk factors, such as infection, prior use of antibiotics, and prior hospitalization, the presence of ECP should be highly suspected[ 3 ]. Additionally, this case highlighted the significance of sensitive recognition of the echocardiographic features of ECP, including pericardial effusion combined with atrial enlargement, which is the most intuitive feature of constrictive pericarditis.…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa-related effusive-constrictive pericarditis diagnosed with echocardiography: A case report

Chen¹,

Mei²,

Yu³

et al. 2022

WJCC

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BACKGROUND Effusive-constrictive pericarditis (ECP) is an uncommon pericardial syndrome. Careful echocardiographic examination may provide helpful information not only for diagnosing but also for managing ECP. ECP has various etiologies; however, Pseudomonas aeruginosa ( P . aeruginosa) infection has not been reported as a cause to date. Herein, we present a rare case of ECP caused by P . aeruginosa infection, which was followed up using echocardiography. CASE SUMMARY A 30-year-old man was admitted to our hospital with a 2-mo history of cough, dyspnea, bloating, palpitations, and lower-extremity edema. The patient was initially diagnosed with pericardial effusion by transthoracic echocardiography. Drainage of pericardial effusion was performed to relieve the clinical symptoms. A follow-up echocardiogram showed that the pericardial effusion had decreased; however, the right atrial pressure continued to increase, and signs of constrictive pericarditis were observed upon a more comprehensive inspection. Therefore, the diagnosis of ECP was established based on the comprehensive pre- and post-pericardiocentesis echocardiographic findings. An urgent pericardectomy was subsequently performed, which significantly relieved the patient's clinical symptoms, and the signs of pericardial constriction on echocardiography improved. Pericardial effusion and pericardial culture showed growth of P . aeruginosa . CONCLUSION ECP induced by P . aeruginosa infection remains a rare disease. The presence of echocardiographic features of constrictive pericarditis after pericardiocentesis therapy is highly indicative of ECP.

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