Non-infectious, caseous necrosis involving constrictive pericarditis treated with pericardiectomy: A case report

In constrictive pericarditis, pericardial inflammation causes the parietal and visceral pericardial layers to adhere to each other and become scarred, resulting in the loss of pericardial elasticity. This condition impedes ventricular filling during diastole. The fibrotic pericardium, by preventing the heart from filling during diastole, leads to a decrease in venous return to the heart. A reduction in venous return secondary to this results in a decrease in cardiac output. This clinical condition is associated with constrictive pericarditis. This case report presents a 61-year-old male patient who was diagnosed with constrictive pericarditis, and has experienced orthopnea and edema in his lower extremities for the past month. An elective transthoracic echocardiogram demonstrated increased pressure on the right ventricle, with a left ventricular ejection fraction of 50%. Contrast-enhanced thorax magnetic resonance imaging revealed intensity changes consistent with pericardium, showing calcified areas between the pericardial layers. Thorax tomography imaging showed dense calcification that extended from the anterior surface of the right atrium and ventricle toward the apex. This patient was diagnosed with constrictive pericarditis, and a pericardiectomy was planned as treatment.