School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Department of Cardiology, University of Texas Medical Branch, Galveston, TX, USA.
Am J Case Rep. 2024 Jun 5;25:e943979. doi: 10.12659/AJCR.943979.
BACKGROUND Effusive-constrictive pericarditis (ECP) is an uncommon clinical syndrome characterized by the coexistence of pericardial effusion and constriction involving the visceral pericardium. This differs from constrictive pericarditis, which presents with thickening of the pericardium without effusions. Specific diagnostic criteria of ECP include the failure of right atrial pressure to decrease by 50% or reach a new level below 10 mmHg after normalization of intrapericardial pressure. CASE REPORT We present the case of a 32-year-old obese man with multiple comorbidities who initially presented with flu-like symptoms and pleural effusion with development of constrictive-like symptoms. Despite undergoing numerous pericardiocentesis and appropriate medical management, the patient's condition failed to improve, leading to the likely diagnosis of effusive-constrictive pericarditis. Cultures of pericardial fluid revealed E. -faecium, which required multiple antimicrobial therapy. Despite infection, the exact etiology of ECP remained unknown and likely idiopathic. Common causes of ECP include idiopathic, tuberculosis, cardiac surgery complications, radiation, or neoplasia. Ultimately, the patient underwent a pericardiectomy involving the visceral and parietal pericardium, resulting in hemodynamic stability and resolution of symptoms. CONCLUSIONS This case highlights the challenges in diagnosing and managing ECP, emphasizing the importance of considering surgical intervention in refractory cases. ECP initially presents as a pericardial effusion, often addressed through pericardiocentesis; however, in a small subset of patients, sustained symptoms and altered hemodynamics persist following pericardiocentesis, necessitating further evaluation and management. The success of pericardiectomy in our patient highlights the potential efficacy of surgical intervention in improving outcomes for patients with ECP.
渗出性缩窄性心包炎（effusive-constrictive pericarditis，ECP）是一种罕见的临床综合征，其特征为心包积液和缩窄同时存在，涉及脏层心包。这与缩窄性心包炎不同，后者表现为心包增厚而无积液。ECP 的特定诊断标准包括在心包内压正常化后右心房压力不能降低 50%或降至 10mmHg 以下。
我们报告了一例 32 岁肥胖男性，合并多种合并症，最初表现为流感样症状和胸腔积液，随后出现缩窄样症状。尽管进行了多次心包穿刺和适当的药物治疗，患者的病情仍未改善，因此可能诊断为渗出性缩窄性心包炎。心包液培养显示粪肠球菌（E. -faecium），需要多次抗菌治疗。尽管存在感染，但 ECP 的确切病因仍不清楚，可能是特发性的。ECP 的常见病因包括特发性、结核、心脏手术并发症、放疗或肿瘤。最终，患者接受了心包切除术，涉及脏层和壁层心包，导致血流动力学稳定和症状缓解。
本病例突出了诊断和管理 ECP 的挑战，强调了在难治性病例中考虑手术干预的重要性。ECP 最初表现为心包积液，通常通过心包穿刺治疗；然而，在一小部分患者中，心包穿刺后持续存在症状和血流动力学改变，需要进一步评估和管理。我们的患者心包切除术成功，突出了手术干预在改善 ECP 患者结局方面的潜在疗效。
