Idiopathic Chronic Constrictive Pericarditis Secondary to Calcified Pericardial Haematoma

Al-Sarraf, Nael; Doddakula, Kishore; Moore, David; McGovern, Eillish

doi:10.2169/internalmedicine.46.6454

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…Localized CP, including annular CP, is known to be rare, and reports of localized CP with giant calcified masses compressing the right ventricular inflow tract are scarce . Once trauma, postsurgical complications, radiation therapy, and tuberculosis have been ruled out, what remains is an occult event that triggers inflammation of the pericardium, eventual fibrosis with calcification, and occasional adherence to the pericardium.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection of enlarged calcification formed by idiopathic localized constrictive pericarditis during total aortic arch replacement for aortic dissection

et al. 2019

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A 75-year-old woman presented at a prior hospital with persistent cough and was treated conservatively for a thrombosed-type aortic dissection (Stanford A). One-year after discharge, follow-up computerized tomography revealed a DeBakey type II, chronic dissecting aortic aneurysm enlarged to 54 mm. She was referred to our hospital with slight edema in the face and extremities and chest radiography showed calcification around the heart. Computerized tomography performed at the prior hospital showed a large spherical mass in the anterior pericardium in addition to the aortic dissection. We therefore resected the mass immediately before a total aortic arch replacement. Surgery was successful and uneventful with patient discharge on postoperative day 21. The final differential diagnosis was idiopathic, localized, constrictive pericarditis. K E Y W O R D S aorta and great vessels, cardiovascular pathology, constrictive pericarditis 1 | INTRODUCTION Constrictive pericarditis (CP) is an uncommon disorder characterized by pericardial thickening, myocardial constriction, and progressively impaired diastolic filling. A number of causes exist, including tuberculosis, uremia, dialysis, viral or bacterial infection, traumatic or nontraumatic pericardial hematoma, and autoimmune disease. Patients often present with generalized symptoms of cardiac failure, such as edema within the extremities and hepatic congestion, but localized pericardial constriction is rarely reported. Although a few cases of CP requiring surgical resection of calcified masses in compressed right ventricles have been reported, idiopathic case reports are scarce. Here, we present an elderly woman with a thrombosed aortic dissection who developed idiopathic, CP-mediated calcification of the anterior pericardium 1 year after the onset of aortic dissection and required a surgical resection of this mass during an aortic arch replacement. | CASE REPORTA 75-year-old woman with persistent cough presented at a prior hospital, where computerized tomography (CT) found a large spherical mass in the anterior pericardium and a thrombosed-type Stanford A aortic dissection with a maximum aortic diameter of 48 mm and false lumen thickness of 7 mm that was treated conservatively. The onset time of the aortic dissection was unknown.One year after the first admission, follow-up CT revealed a false lumen communication and the ascending aorta was enlarged to 54 mm in diameter. She was referred to our hospital for surgery and complained of fatigue upon admission. She denied any previous history of chest wall trauma or bleeding disorders and had no history of tuberculosis or radiation therapy.CT and X-rays performed at the prior hospital also showed a large spherical mass in the anterior pericardium compressing the right atrium and ventricle in addition to the referred aortic dissection J Card Surg. 2019;34:511-513.wileyonlinelibrary.com/journal/jocs

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Section: Discussionmentioning

confidence: 99%

Surgical resection of enlarged calcification formed by idiopathic localized constrictive pericarditis during total aortic arch replacement for aortic dissection

et al. 2019

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“…Often there is an occult event that triggers inflammation of the pericardium, leading to fibrosis with calcification and sometimes adherences on the pericardium. Sometimes small collections of fluid entrapped between adhesions in patients with constrictive pericarditis are reported [9] . The giant mass observed in the case presented here consisted of a thick layer of calcified tissue within the pericardial cavity.…”

Section: Discussionmentioning

confidence: 99%

Localized constrictive pericarditis compressing and obstructing the right ventricular inflow tract due to a giant anterior calcified cardiac mass. A case report

Krakulli

Prifti

Gjergo

et al. 2017

International Journal of Surgery Case Reports

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HighlightsConstrictive pericarditis is a rare disorder, characterized by thick pericardial fibrosis and calcification that causes progressively impaired diastolic filling of the heart with associated symptoms of heart failure.We report a case with localized anterior calcified constrictive pericarditis with a large hematoma formation obstructing the right ventricular inflow tract.A contrast enhanced angio computerized tomography clearly demonstrated a large spherical mass about 11 × 9 × 4 cm in the anterior pericardium, presenting as a mediastinal tumor and compressing right ventricle inflow tract.With evidence of constriction confirmed, the patient underwent pericardiectomy and resection of the mass. Before sternotomy, the central venous pressure was 20 mmHg.The dissection was started from the anterior surface of the right ventricle toward the mass on the right atrioventricular groove. The outer calcified layer of the pericardial mass was a thick layer of calcification surrounded an inner amorphous low density material. This layer was easily opened and the contents of the mass appeared like old coagulated blood which was evacuated with a sterile spoon.The inferior calcified layer of the pericardial mass was carefully excised from the great vessels' origins to the diaphragm and all areas between the right and left phrenic nerves, without employimg the cardiopulmonary bypass.Constrictive pericarditis should be taken itno consideration when generalized symptoms of right-sided heart failure and decreased cardiac output are present.The differential diagnosis with other calcified masses in the anterior mediastinum such as teratoma, hemopericardium after blunt trauma and idiopathic or tuberculous constrictive pericarditis should be considered. The most common etiologies of this disorder are viral infection, renal failure, tuberculosis, radiation therapy, collagen vascular disease, prior pericardiotomy, and idiopathic constrictive pericarditis.The mechanism by which such a large amount of coagulated blood was entrapped within the mass was unclear. The inflammatory changes of the pericardium might lead to neovascular process, which is often fragile, easily ruptured, and results in a large amount of blood in the cavity. Indeed, blood was confined in the cavity mass. Pericarditis is a common cause of obstruction of cardiac structures.Pericardectomy is the only established treatment for chronic constrictive pericarditis. Careful dissection is mandatory for a successful procedure.When clinical conditions support the presence of infection, the papillary fibroelastoma may be misdiagnosed as a vegetation due to endocarditis.The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences.Careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis.Immediate surgical removal and valve repair or replacement are the procedure of choice.

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“…However, if pericardial hematoma develops and persists, it will induce intrapericardial inflammation, granulation tissue formation, adhesions and calcification leading to constriction. (7) In the chronic form, the patient may present after a latent period with breathlessness, chest tightness, ankle swelling, cyanosis, facial and neck swelling with elevated jugular venous pressure and lower limb edema. (7) In the present case, the diagnosis of intrapericardial hematoma as a cause of the patient's symptoms was not seriously considered pre-operatively.…”

Section: Discussionmentioning

confidence: 99%

“…(7) In the chronic form, the patient may present after a latent period with breathlessness, chest tightness, ankle swelling, cyanosis, facial and neck swelling with elevated jugular venous pressure and lower limb edema. (7) In the present case, the diagnosis of intrapericardial hematoma as a cause of the patient's symptoms was not seriously considered pre-operatively. A mass of malignant or inflammatory origin attached to the heart was suspected, however diagnosis was established only postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Large Organized Intrapericardial Hematoma Presenting as a Case of Constrictive Pericarditis and Superior Vena Cava Syndrome

Soub

Ahmedulla

2012

Qatar Medical Journal

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Superior vena cava syndrome and constrictive pericarditis are rare complications of intrapericardial hematoma. We herein report a young patient presenting with a mass attached to the heart causing pressure on the right atrium and superior vena cava, and leading to superior vena cava syndrome and constrictive pericarditis. The exact pathogenesis was not determined but possibly was related to pericardiocentesis 29 years prior to presentation. Diagnosis was established at surgery and confirmed by histopathology. Resolution was partial because complete resection was not possible due to adherence of the mass to the right ventricular wall.

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Idiopathic Chronic Constrictive Pericarditis Secondary to Calcified Pericardial Haematoma

Cited by 5 publications

References 7 publications

Surgical resection of enlarged calcification formed by idiopathic localized constrictive pericarditis during total aortic arch replacement for aortic dissection

Surgical resection of enlarged calcification formed by idiopathic localized constrictive pericarditis during total aortic arch replacement for aortic dissection

Localized constrictive pericarditis compressing and obstructing the right ventricular inflow tract due to a giant anterior calcified cardiac mass. A case report

Large Organized Intrapericardial Hematoma Presenting as a Case of Constrictive Pericarditis and Superior Vena Cava Syndrome

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