“Open top flask” sign

Abstract

It is very rare to encounter tubercular chronic constrictive pericarditis and hypertrophic cardiomyopathy together. A 49-year-old man with a history of tuberculosis was evaluated for right heart failure. There was extensive pericardial calcification, fibrosis and calcification of the left lung, and hypertrophic obstructive cardiomyopathy ( Figure 1, Video 1). The coronary angiogram was normal. The systolic and diastolic movement of the right coronary artery in the densely calcified pericardial cavity was interesting (Figure 2, Video 2). The densely calcified pericardial cavity with the top being relatively free of calcification resembled an open top flask. A left ventricular angiogram was suggestive of hypertrophic obstructive cardiomyopathy (Video 3). Pericardial resection and Morrow's procedure were performed in the same session.Figure 1. (A) Chest radiograph in posteroanterior projection, showing the stigma of old healed Koch's disease (fibrosis and calcification in the left lung; arrow A) and a densely calcified pericardium (arrow B). (B) Left ventricular angiogram in right anterior oblique view, showing densely calcified pericardium in the atrioventricular groove (arrow A) and significant left ventricular outflow tract obstruction (arrow B).Figure 2. Right coronary angiogram in right anterior oblique view, showing a normal right coronary artery surrounded by thick and densely calcified pericardium. The pericardial cavity was relatively free of calcification at the top (''open top flask'').