Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge


  • Shi-Min Yuan



Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.


Aagaard J, Jensen LI, Sørensen TI, Christensen U, Burcharth F. 1982. Recanalized umbilical vein in portal hypertension. AJR Am J Roentgenol. 139:1107-10.nBashi VV, John S, Ravikumar E, Jairaj PS, Shyamsunder K, Krishnaswami S. 1988. Early and late results of pericardiectomy in 118 cases of constrictive pericarditis. Thorax 43:637-41.nBerzigotti A, Ashkenazi E, Reverter E, Abraldes JG, Bosch J. 2011. Noninvasive diagnostic and prognostic evaluation of liver cirrhosis and portal hypertension. Dis Markers 31:129-38.nBozbuga N, Erentug V, Eren E, et al. 2003. Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival. Tex Heart Inst J 30:180-5.nButany J, El Demellawy D, Collins MJ, et al. 2004. Constrictive pericarditis: case presentation and a review of the literature. Can J Cardiol 20:1137-44.nCinar B, Enç Y, Göksel O, et al. 2006. Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy. Int J Tuberc Lung Dis 10:701-6.nElkayam U, Kotler MN, Segal B, Parry W. 1976. Echocardiographic findings in constrictive pericarditis. A case report. Isr J Med Sci 12:1308-12.nGoyle KK, Walling AD. 2002. Diagnosing pericarditis. Am Fam Physician 66:1695-702.nJohnson KT, Julsrud PR, Johnson CD. 2008. Constrictive pericarditis at abdominal CT: a commonly overlooked diagnosis. Abdom Imaging 33:349-352.nKameda Y, Funabashi N, Kawakubo M, et al. 2007. Heart in an eggshell-appearance calcified constrictive pericarditis demonstrated by three-dimensional images of multislice computed tomography. Int J Cardiol 120:269-72.nLima MV, Cardoso JN, Cardoso CM, Brancalhão EC, Limaco RP, Barretto AC. 2011. Constrictive pericarditis with extensive calcification. Arq Bras Cardiol 96:e7-10.nLing LH, Oh JK, Breen JF, et al. 2000. Calcific constrictive pericarditis: is it still with us? Ann Intern Med 132:444-50.nMacGregor JH, Chen JT, Chiles C, Kier R, Godwin JD, Ravin CE. 1987. The radiographic distinction between pericardial and myocardial calcifications. AJR Am J Roentgenol 148:675-7.nMeszaros K, Wagner D, Müller H, et al. 2013. Liver cirrhosis cured by pericardiectomy-a rare case of constrictive, non-calcifying pericarditis. J Clin Exp Cardiolog 4:1000242.nO'Leary SM, Williams PL, Williams MP, et al. 2010. Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography. Br J Radiol 83:194-205.nPeset AM, Martí V, Cardona M, Montiel J, Guindo J, Domínguez de Rozas JM. 2007. Outcome of pericardiectomy for chronic constrictive pericarditis. Rev Esp Cardiol 60:1097-101 [In Spanish].nRunyon BA, Akriviadis EA, Keyser AJ. 1991. The opacity of portal hypertension-related ascites correlates with the fluid's triglyceride concentration. Am J Clin Pathol 96:142-3.nSzabó G, Schmack B, Bulut C, et al. 2013. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg 44:1023-8, discussion 1028.nTiruvoipati R, Naik RD, Loubani M, Billa GN. 2003. Surgical approach for pericardiectomy: a comparative study between median sternotomy and left anterolateral thoracotomy. Interact Cardiovasc Thorac Surg 2:322-6.nTugcu A, Yildirimturk O, Duran C, Aytekin S. 2008. Constrictive pericarditis impressing and narrowing the ascending aorta. Echocardiography 25:768-71.n



How to Cite

Yuan, S.-M. (2014). Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge. The Heart Surgery Forum, 17(1), E42-E46.