Vaysblat Michael, Kang Gurjaipaul, Panjwani Beatrice, Dastagir Manile, Roarke Dennis T
Internal Medicine, Northwell Health, New York, USA.
Radiology, Northwell Health, New York, USA.
Cureus. 2023 Jul 10;15(7):e41626. doi: 10.7759/cureus.41626. eCollection 2023 Jul.
Constrictive pericarditis (CP) is a disease primarily affecting the pericardial sac surrounding the heart. The constrictive physiology placed on the heart chambers can lead to clinical presentations mimicking heart failure and possibly primary liver disease. The diagnosis can often be missed and attributed to other etiologies until the patient undergoes extensive workup to rule out each potential etiology. Diagnosis can be delayed, leading to suboptimal outcomes and mortality rates. Here, we present a case of CP initially presenting with bilateral lower extremity and scrotal edema, initially attributed to alcoholic liver cirrhosis given the patient's history of alcohol abuse. Subsequent abdominal imaging found no evidence of cirrhosis, coupled with grossly normal echocardiogram that led to extensive workup and eventually the diagnosis of CP based on cardiac MRI. The patient later underwent pericardiectomy and made a full recovery. This case highlights the often ambiguous presentation of CP, the utility of cardiac MRI in diagnosis, and the need for specific criteria to help guide future diagnoses as imaging modalities continue to evolve.
缩窄性心包炎（CP）是一种主要影响心脏周围心包囊的疾病。心脏腔室所受的缩窄性生理改变可导致类似心力衰竭甚至可能类似原发性肝病的临床表现。在患者接受全面检查以排除每种潜在病因之前，诊断常常会被漏诊并归因于其他病因。诊断可能会延迟，导致预后不佳和死亡率上升。在此，我们报告一例CP病例，该患者最初表现为双侧下肢和阴囊水肿，鉴于其有酗酒史，最初被归因于酒精性肝硬化。随后的腹部影像学检查未发现肝硬化证据，加上超声心动图基本正常，这促使进行了全面检查，最终基于心脏磁共振成像（MRI）诊断为CP。该患者后来接受了心包切除术并完全康复。本病例突出了CP常常模糊不清的表现、心脏MRI在诊断中的作用，以及随着成像技术不断发展，需要有特定标准来帮助指导未来诊断。
