A Case of Circumferential Calcific Constrictive Pericarditis with a Compressive Collection

Calcific constrictive pericarditis is an uncommon, yet severe manifestation of chronic pericardial inflammation, leading to diastolic heart failure through lower myocardial compliance secondary to pericardial stiffening. Its etiologies are diverse, including infectious, iatrogenic and autoimmune causes, with tuberculosis remaining a primary offender in endemic regions.

We present the case of a 67-year-old male with a history of chronic obstructive pulmonary disease (COPD) and permanent atrial fibrillation, admitted with decompensated global heart failure. Chest radiography revealed extensive, circumferential pericardial calcifications, resembling a plate armour, and a large, calcified saccular collection. Echocardiography confirmed features of constriction, including septal bounce and annulus reversus. Computed tomography further delineated the “armored heart” morphology and a large, compressive, calcified collection over the right ventricle. Diagnostic pericardiocentesis yielded a smooth, “café au lait” coloured fluid. While microbiological analysis for Mycobacterium tuberculosis was negative, the pericardial fluid Adenosine Deaminase (ADA) level was exceptionally high at 952 U/L. The diagnosis of tuberculous effusive-constrictive pericarditis in its late, burnt-out fibrocalcific stage was thus established.

This case provides a striking visual correlation between classic clinical signs of constriction and their underlying anatomical pathology, underscoring the diagnostic utility of ADA in culturenegative cases.