- Email: [email protected]
Localized Calcific Constrictive Pericarditis Masquerading as a Basal Aneurysm
Journal of the American College of Cardiology © 2011 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 57, No. 18, 2011 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2010.08.652
IMAGES IN CARDIOLOGY
Localized Calcific Constrictive Pericarditis Masquerading as a Basal Aneurysm Michael J. Blaha, MD, MPH, Gurusher Panjrath, MD, Matthews Chacko, MD, Steven P. Schulman, MD Baltimore, Maryland
From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland. Manuscript received July 28, 2010; accepted August 4, 2010.
A
70-year-old woman presented with worsening dyspnea on minimal exertion and an echocardiogram notable for possible basal aneurysm (A, Online Video 1). A chest X-ray showed diffuse pericardial calcification, and a cardiac magnetic resonance imaging scan showed biatrial enlargement and a thickened pericardium compressing the mid to apical left ventricle (B, Online Videos 2 and 3). Fluoroscopy revealed a band of pericardial calcification (C, Online Video 4) and simultaneous right and left heart catheterization demonstrated equalization of pressures, respirophasic discordance of the ventricular pressure tracings, and square root sign with a steep right atrial “y” descent suggesting constrictive physiology. Ventriculography showed compression of the mid to apical left ventricle, giving an unusual appearance that could be misinterpreted as a basal aneurysm (D). Cardiac computed tomography angiography revealed severe pericardial calcification in a “belt-like” pattern around the mid-ventricle (E, Online Video 5). After a long discussion, the patient stated that she “wanted her life back” and requested surgical pericardectomy. Unfortunately, she died perioperatively. She had no history of tuberculosis or mediastinal radiation.
Vol. 57, No. 18, 2011 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2010.08.652
IMAGES IN CARDIOLOGY
Localized Calcific Constrictive Pericarditis Masquerading as a Basal Aneurysm Michael J. Blaha, MD, MPH, Gurusher Panjrath, MD, Matthews Chacko, MD, Steven P. Schulman, MD Baltimore, Maryland
From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland. Manuscript received July 28, 2010; accepted August 4, 2010.
A
70-year-old woman presented with worsening dyspnea on minimal exertion and an echocardiogram notable for possible basal aneurysm (A, Online Video 1). A chest X-ray showed diffuse pericardial calcification, and a cardiac magnetic resonance imaging scan showed biatrial enlargement and a thickened pericardium compressing the mid to apical left ventricle (B, Online Videos 2 and 3). Fluoroscopy revealed a band of pericardial calcification (C, Online Video 4) and simultaneous right and left heart catheterization demonstrated equalization of pressures, respirophasic discordance of the ventricular pressure tracings, and square root sign with a steep right atrial “y” descent suggesting constrictive physiology. Ventriculography showed compression of the mid to apical left ventricle, giving an unusual appearance that could be misinterpreted as a basal aneurysm (D). Cardiac computed tomography angiography revealed severe pericardial calcification in a “belt-like” pattern around the mid-ventricle (E, Online Video 5). After a long discussion, the patient stated that she “wanted her life back” and requested surgical pericardectomy. Unfortunately, she died perioperatively. She had no history of tuberculosis or mediastinal radiation.