https://orcid.org/0000-0001-5849-5817
A 30-year-old patient, with a history of recurrent pericarditis, presented with progressive dyspnoea and abdominal pain. Upon physical examination, bilateral jugular distension, hepatomegaly, and lower extremity oedema were observed. Blood tests revealed elevated levels of B-type natriuretic peptide. Transthoracic echocardiogram and cardiovascular magnetic resonance cine images (images of the beating heart) disclosed paradoxical movement of the interventricular septum (see Supplementary data online, Videos S1 and S2) and Doppler unveiled a 40% respiratory variation in transvalvular mitral flow, suggesting constrictive physiology (Panel A) consistent with constrictive pericarditis.
For a more comprehensive assessment of the calcified component, chest computed tomography (CT) and three-dimensional Volumetric Rendering reconstructions were performed. The images displayed circumferential calcification of the pericardium (Panels B and C; see Supplementary data online, Video S3), including the free wall of the right ventricle (arrow) and the inferolateral wall of the left ventricle (arrowhead). Despite drug therapy, there was no clinical improvement, and after surgical evaluation, the patient underwent a partial pericardiectomy.
Post-operative imaging studies were conducted as part of the follow-up. Improvement in ventricular filling and mitral flow (Panel C) was seen, along with a slight residual septal bounce (see Supplementary data online, Videos S4 and S5). CT reconstructions (Panels E and F; see Supplementary data online, Video S6) illustrated the resection of calcifications in the free wall of the right ventricle (arrow) and residual calcification at the inferior and inferolateral wall of the left ventricle (arrowhead).
Non-invasive imaging techniques enable precise evaluation of pericardial anatomy. In cases of constrictive pericarditis, advancements in multimodality imaging have facilitated the recognition of different stages of the pathology, guiding timely interventions and evaluating post-intervention results, complications, and recurrence.
Supplementary data are available at European Heart Journal—Cardiovascular Imaging online.
Funding: Authors declared no funding for this work.
Data availability: No data were generated or analysed during the study.
Author notes
Conflict of interest: None declared.
