Calcific visceral pericardial constriction.

1 of 3 DESCRIPTION A middle-aged hypertensive lady was admitted with progressive weight gain and generalised edema of 1-year duration. Examination revealed a raised jugular venous pressure, anasarca, atrial fi brillation and no signifi cant murmurs. Evaluation revealed mild anaemia with raised erythrocyte sedimentation rate. Chest radiograph and echocardiography revealed cardiomegaly, biatrial enlargement, IVC congestion, moderate pericardial effusion and signifi cant atrioventricular valve respiratory variation. Fluoroscopy and catheterisation study showed pericardial calcifi cation ( fi gure 1 , arrows) and confi rmed fi ndings of constrictive physiology with a typical ‘square-root confi guration’. CT scan ( fi gure 2 , arrows) showed pericardial effusion with thin, linear visceral pericardial calcifi cation seen at the level of main pulmonary trunk and base of the heart in relation to the right and left ventricles sparing the parietal pericardium. The patient underwent surgical pericardiectomy. Thick whitish fi brous peel ( fi gure 3 , arrows) encircling the heart with calcifi cation over the right ventricle and its outfl ow tract was dissected carefully. Four hundred millilitres of serosanguinous fl uid was drained. Parietal pericardium was normal. Biopsy showed infl ammatory infi ltrates, fi brocollagenous tissue and no granulomas. Idiopathic isolated visceral calcifi c constriction was diagnosed, which is rare. 1 Patient at 6 Images in...