Constrictive Pericarditis With Pseudocirrhosis Secondary to Compression of Right Cardiac Chambers by Huge Calcific Pericardial Cystic Mass
2014; Lippincott Williams & Wilkins; Volume: 129; Issue: 20 Linguagem: Inglês
10.1161/circulationaha.113.007534
ISSN1524-4539
AutoresYoshihisa Morimoto, Takaki Sugimoto, Hideki Sakahira, Hiroki Arase, Kota Araki,
Tópico(s)Myasthenia Gravis and Thymoma
ResumoHomeCirculationVol. 129, No. 20Constrictive Pericarditis With Pseudocirrhosis Secondary to Compression of Right Cardiac Chambers by Huge Calcific Pericardial Cystic Mass Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBConstrictive Pericarditis With Pseudocirrhosis Secondary to Compression of Right Cardiac Chambers by Huge Calcific Pericardial Cystic Mass Yoshihisa Morimoto, MD, PhD, Takaki Sugimoto, MD, PhD, Hideki Sakahira, MD, PhD, Hiroki Arase, MD and Kota Araki, MD Yoshihisa MorimotoYoshihisa Morimoto From the Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan. , Takaki SugimotoTakaki Sugimoto From the Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan. , Hideki SakahiraHideki Sakahira From the Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan. , Hiroki AraseHiroki Arase From the Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan. and Kota ArakiKota Araki From the Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan. Originally published20 May 2014https://doi.org/10.1161/CIRCULATIONAHA.113.007534Circulation. 2014;129:2080–2082IntroductionA 73-year-old male patient was admitted to our cardiology department with complaints of exertional dyspnea and abdominal distention of 6 months' duration. He had complained of fatigue and shortness of breath, which corresponded to New York Heart Association class III symptoms, so his physician had put him on oral diuretics.On physical examination, his heart rate was 93 bpm. The liver was enlarged and palpable 10 cm below the right costal margin. Muffled heart sounds without murmur, venous dilatation of the extremities, neck vein distension, hepatojugular reflux, and abdominal ascites were detected. Chest x-ray showed bilateral pleural effusion but did not demonstrate a hyperdense calcific mass (Figure 1). Transthoracic echocardiography showed unclear but detected compression of right cardiac chambers, dilated inferior vena cava with reduced inspiratory collapse, mild tricuspid valve regurgitation, and an estimated right ventricular systolic pressure of 46 mm Hg, whereas the left heart system was normal. Computed tomography (Figure 2) and transesophageal echocardiography (Figure 3 and Movie I in the online-only Data Supplement) displayed a 48×46×38-mm high-density area, a cystic lesion located in the anterior mediastinum adjacent to the right cardiac chambers, and bilateral pleural effusion.Download figureDownload PowerPointFigure 1. A, A chest radiograph taken at the patient's first visit showed bilateral pleural effusion. B, A postoperative chest radiograph showed no pleural effusion.Download figureDownload PowerPointFigure 2. Preoperative computed tomography images. A, Horizontal view. A large calcific cystic mass is compressing right cardiac chambers. B, Axial view. C, Anterior view of the 3-dimensional reconstruction image. Top, A large calcific cystic mass and bones. Bottom, A large calcific cystic mass and a heart. D, Left lateral view of the 3-dimensional reconstruction image. Top, A large calcific cystic mass. Bottom, A large calcific cystic mass and the heart. E, Posterior view of the 3-dimensional reconstruction image.Download figureDownload PowerPointFigure 3. Preoperative transesophageal echocardiography showed a large pericardial mass (arrow) with compression of the right ventricle (RV). LA indicates left atrium; LV, left ventricle; and RA, right atrium.We scheduled elective surgery. He underwent pericardial resection via median sternotomy without cardiopulmonary bypass (Movie II in the online-only Data Supplement). Despite careful removal of the cyst, the right ventricle could not unfold properly as a result of local constriction. Only after local epicardectomy could the right ventricle could unfold again. A cystic mass with thickened calcific fibrous tissue located anterior to the right cardiac chambers was removed, and brown fluid was aspirated. Central venous pressure and pulmonary arterial systolic pressure decreased from 33 and 66 mm Hg to 16 and 38 mm Hg.Histopathological examination of the excised pericardial cysts revealed moderate nonspecific, noncellular inflammation, calcification, and thickened connective tissue. There was no pathogen agent. The pathological diagnosis was compatible with idiopathic constrictive pericarditis (CP). The follow-up after surgery was uneventful. At 6 months after surgery, the patient was considered to be in New York Heart Association class I.Considering that the patient had no previous episode of cardiac trauma or surgery, mediastinal irradiation, tuberculosis, or other infectious diseases or neoplasms, he may have chronic subclinical pericardial inflammation.CP, an uncommon entity, is characterized by an inflammatory process that leads to progressive pericardial fibrosis encasing the heart in a thickened, fibrotic pericardium.Localized CP is rare.1–3 Only 1 case with pseudocirrhosis secondary to compression of right cardiac chambers by localized CP has been reported.4 This patient had a similar picture. The diagnosis of CP is often difficult to make. In fact, CP shows various symptoms, and cirrhosis-like symptoms is rare.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.113.007534/-/DC1.Correspondence to Yoshihisa Morimoto, MD, PhD, Division of Cardiovascular Surgery, Awaji Medical Center, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan. E-mail [email protected]References1. Alsemgeest F, Spiegelenberg SR, Kamp O. Cholesterol pericarditis with massive pericardial cholesterol cyst.Eur Heart J. 2012; 33:1554.CrossrefMedlineGoogle Scholar2. Blaha MJ, Panjrath G, Chacko M, Schulman SP. Localized calcific constrictive pericarditis masquerading as a basal aneurysm.J Am Coll Cardiol. 2011; 57:e65.CrossrefMedlineGoogle Scholar3. Hamdulay ZA, Kumar P, Ali M, Bhojraj SS, Jain SB, Patwardhan AM. Localized pericardial constriction resulting in a "dumbbell" heart.Ann Thorac Surg. 2007; 83:2222–2224.CrossrefMedlineGoogle Scholar4. Akpinar I, Tüfekçioğlu O, Yücel E, Okten RS. Pseudocirrhosis; constrictive pericarditis due to huge calcific pericardial cystic mass compressing right cardiac chambers.Anadolu Kardiyol Derg. 2012; 12:E24–E25.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sliman H, Sharoni E, Adawi S, Leviner D, Karkabi B, Zissman K and Zafrir B (2021) Pericardial constriction with calcified cystic mass compressing the right ventricle and right coronary artery, Journal of Cardiology Cases, 10.1016/j.jccase.2021.02.010, 24:3, (118-121), Online publication date: 1-Sep-2021. Xie X, Wan J and Yu F (2020) Right ventricular dysfunction due to effusive‐constrictive pericarditis, Journal of Cardiac Surgery, 10.1111/jocs.15032, 35:12, (3569-3570), Online publication date: 1-Dec-2020. Güvenç T, Hayıroğlu M, Gümüşdağ A, Ekmekçi A, Erer H, Keskin M and Eren M (2016) Giant calcific pericardial cyst: certainly unexpected during primary percutaneous coronary intervention, Echocardiography, 10.1111/echo.13315, 33:12, (1934-1935), Online publication date: 1-Dec-2016. May 20, 2014Vol 129, Issue 20 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.113.007534PMID: 24842936 Originally publishedMay 20, 2014 PDF download Advertisement SubjectsCardiovascular SurgeryTreatment
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