Cirugía y Cirujanos

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirugía y Cirujanos >Year 2010, Issue 4

Castañón-González JA, Amézquita-Landeros JA, Velasco-Ortega EC, Deseano-Estudillo JL, León-Gutiérrez MA
Constrictive pericarditis: the history of a constrained heart
Cir Cir 2010; 78 (4)

Language: Español
References: 13
Page: 342-346
PDF: 370.59 Kb.

Full text


Background: Symptoms of constrictive pericarditis may be nonspecific, misleading and may delay or lead to an incorrect diagnosis. Clinical case: We present the case of a 28-year-old male who was admitted to the hospital with progressive dyspnea, thoracic pain and a history of 25 kg of weight gain during the last 2 years. He was evaluated at another facility and his clinical presentation led to an erroneous diagnosis of primary hepatic disease (cirrhosis and portal hypertension). Physical examination showed that he was dyspneic, emaciated, had marked distention of his frontal cranial veins, diminished heart sounds, massive ascites and leg edema. Laboratory tests reported abnormal liver function tests and abdominal paracentesis chylousas cites. Electrocardiogram showed sinus rhythm with generalized low voltage and nonspecific repolarization changes. Heart size was normal on chest radiography. Doppler echocardiography reported bilateral atrial dilatation, a thickened pericardium and a short deceleration time of transmitral flow. A thickened and calcified pericardium was seen on CT scan. Pericardiectomy was performed. Spontaneous polyuria was observed during and after surgery with subsequent improvement of ascites and edema. The pericardium was found to be grossly thickened and inflamed.
Conclusions: Clinician must be aware of the slow and progressive course of right ventricular failure, as well as to recognize constrictive pericarditis as a cause of chronic ascites. The hemodynamic aspects of the disease are of paramount importance for early diagnosis and opportune treatment.

Key words: Chylous ascites, constrictive pericarditis, pericardiectomy.


  1. Broadbent WH, Broadbent JFH. Adherent pericardium In: Willius FA, Keys TE, eds. Cardiac Classics. A Collection of Classic Works on the Heart and Circulation with Comprehensive Biographic Accounts of the Authors. St Louis, MO: Mosby; 1941. pp. 711-715.

  2. Bruce AR. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fortran´s Gastrointestinal and Liver Disease, Pathophysiology, Diagnosis, Management. 8th ed. Philadelphia: Saunders Elsevier; 2006. pp. 1935-1966.

  3. Rector WG. Spontaneous chylous ascites of cirrhosis. J Clin Gastroenterol 1984:6:369-372.

  4. Press OW, Press NO, Kaufman SD. Evaluation and management of chylous ascites. Ann Intern Med 1982;96:358-364.

  5. Hoffman BJ, Pate MB, Marsh WH, Lee WM. Cardiomyopathy unrecognized as a cause of hepatic failure. J Clin Gastroenterol 1990;12:306- 309.

  6. Van der Merwe S, Dens J, Daenen W, Desmet V, Fevery J. Pericardial disease is often not recognised as a cause of chronic severe ascites. J Hepatol 2000;32:164-169.

  7. Arora A, Seth S, Acharya SK, Sharma MP. Hepatic coma as a presenting feature of constrictive pericarditis. Am J Gastroenterol 1993;88:430- 432.

  8. Lowe MD, Harcombe AA, Grace AA, Petch MC. Restrictive-constrictive heart failure masquerading as liver disease. BMJ 1999;318:585-586.

  9. Hancock EW. Subacute effusive-constrictive pericarditis. Circulation 1971;43:183-192.

  10. Fowler NO. Pericardial disease. Heart Dis Stroke 1992;1:85-94.

  11. Kushwaha SS, Fallon JT, Fuster V. Restrictive cardiomyopathy. N Engl J Med 1997;336:267-276.

  12. Kronzon I, Fedor M, Schwartz D, Gallo G, Jacobson DR. A 58-yearold man with shortness of breath, ascites, and leg edema. Circulation 1996;94:1483-1488.

  13. Williams AT, Schneider RP. Chylous ascites should suggest constrictive pericarditis even in a patient with cirrhosis. J Clin Gastroenterol 1990;12:581-584.

>Journals >Cirugía y Cirujanos >Year 2010, Issue 4

· Journal Index 
· Links 

Copyright 2019