A 58-year-old man presented to the clinic with a 1-month history of bilateral leg edema, abdominal swelling, and shortness of breath. He was diagnosed with acute pericarditis 4 months earlier and treated with ibuprofen. The exam demonstrated jugular venous distension and bilateral leg edema. Echocardiography showed a pericardial effusion, normal biventricular function, paradoxical septal motion, and dilated inferior vena cava. Cardiac magnetic resonance imaging (MRI) demonstrated pericardial thickening (4 mm), pericardial effusion with adhesions, and paradoxical septal motion (Figure 1A, Video 1). Contrast enhancement of the pericardium indicated inflammation (Figure 1B) and revealed interdependence of the ventricles on respiration (Video 2). The patient was treated with ibuprofen, colchicine, and corticosteroids. Effusive constrictive pericarditis can complicate pericarditis, particularly if not sufficiently treated, but may resolve with anti-inflammatory therapy. The patient had resolution of pericardial enhancement on follow-up imaging but had persistent pericardial thickening and constriction. He underwent successful pericardiectomy and was well at 6-month follow-up.
Figure 1
(A) Cardiac magnetic resonance imaging (MRI) 4-chamber view demonstrates pericardial thickening with associated pericardial effusion and focal adhesions. (B) Post-contrast cardiac MRI demonstrates a pericardial effusion with circumferential pericardial enhancement reflecting active inflammatory involvement.
Video 1
Cine cardiac magnetic resonance imaging demonstrates paradoxical interventricular septal motion during systole; see also at https://vimeo.com/1162244467/fc43fe2a45.
Video 2
Cine cardiac magnetic resonance imaging demonstrates ventricular interdependence with pronounced respirophasic septal shift, consistent with constrictive physiology; see also at https://vimeo.com/1162246089/a9ce113cf0.
Competing Interests
The authors have no competing interests to declare.