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Case of the Week 249

What's the most likely diagnosis?

  • 47 year-old with dyspnea

  1. Restrictive cardiomyopathy
  2. Constrictive pericarditis
  3. Asbestos-related pleural disease
  4. Sarcoidosis
  5. Mesothelioma



2. Constrictive pericarditis



More (Click Discussion Tab)

Constrictive pericarditis

General considerations

  • Defined by thickening of pericardium (>4mm) impeding diastolic filling
  • Thickened pericardium may calcify (50%)
  • Calcified pericardium almost always implies constriction, but not always
  • About 50% of calcified pericardiums are visible on conventional radiography
  • Calcification of the pericardium is most likely inflammatory in nature
    • Can be seen with a variety of infections, trauma, and neoplasms
    • Most common causes include
      • Viral pericarditis (most common)
      • Tuberculous pericarditis
      • Uremic pericarditis
      • Post-cardiac surgery
  • Calcification most commonly occurs along the inferior diaphragmatic surface of the pericardium surrounding the ventricles
    • Thin, egg-shell like calcification is more often associated with viral infection or uremia
    • Calcification from old TB is often thick, confluent, and irregular in appearance, especially when compared with myocardial calcification


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