Department of Medicine, Medical University of South Carolina, Charleston, USA.
J Investig Med High Impact Case Rep. 2022 Jan-Dec;10:23247096221097530. doi: 10.1177/23247096221097530.
Although well documented, constrictive pericarditis is a rare entity and an uncommon cause of heart failure. A stiff and noncompliant pericardium creates the disease's unique hemodynamics and leads to elevated venous pressures, hepatic sinusoidal congestion, and draining of protein-rich fluid into the peritoneal cavity presenting as ascites. The low incidence in addition to its varied and subtle clinical presentations can often lead to a delay in diagnosis. Here, we present 2 clinical cases of constrictive pericarditis in which ascitic fluid analysis was important-one patient who presented with new-onset ascites with concern for cirrhosis and another patient who presented with symptoms concerning for heart failure with ascites. Through their hospital course and workup, we highlight the importance of diagnostic sampling of ascitic fluid to prompt the consideration of constrictive pericarditis followed by utilizing advanced diagnostics, such as echocardiogram and cardiac catheterization to reach the correct diagnosis in an otherwise often overlooked pathology.
尽管已有充分的文献记载，但缩窄性心包炎是一种罕见的疾病，也是心力衰竭不太常见的病因。坚硬且缺乏顺应性的心包会导致该病独特的血液动力学变化，进而导致静脉压升高、肝窦充血，并使富含蛋白质的液体引流到腹腔，表现为腹水。其发病率低，加之临床表现多样且不明显，往往会导致诊断延迟。在此，我们介绍了 2 例缩窄性心包炎的临床病例，其中腹水分析很重要——1 例患者因新出现的腹水就诊，病因考虑为肝硬化，另 1 例患者因疑似心力衰竭合并腹水就诊。通过他们的住院过程和检查，我们强调了诊断性腹水取样的重要性，以促使考虑缩窄性心包炎，然后利用超声心动图和心导管等先进诊断方法来明确诊断，否则这种疾病往往会被忽视。
