effusive constrictive pericarditis

Pathology

• pericarditis involving the visceral layer of the pericardium
• pericardial inflammation resulting in pericardial effusion placed under pressure by the inelastic pericardium

Clinical manifestations

• persistent symptoms & hemodynamic compromise after pericardiocentesis & drainage of pericardial effusion*
  • case of persistent elevation of right atrial pressure following pericardiocentesis
• also see constrictive pericardiditis
  • low cardiac output
  • systemic congestion
  • elevated jugular venous pulse
    • y descent may be diminished*
  • peripheral edema
  • hepatomegaly
• pericardial knock is absent*
• pulsus paradoxus may be present*

* distinguishes effusive constrictive pericarditis

Laboratory

• also see constrictive pericarditis
• erythrocyte sedimentation rate may be elevated
• complete blood count (CBC) may show leukocytosis
• adenosine deaminase in pericardial fluid to rule out tuberculosis

Diagnostic procedures

• electrocardiogram may be normal
• pericardiocentesis

Radiology

• echocardiogram
  • persistence of elevated right atrial pressure & left ventricular end diastolic pressure after pericardiocentesis & drainage
• cardiac CT
• thickening of the visceral pericardium may be difficult to see on imaging

Management

• also see constrictive pericarditis
• 1st line: glucocorticoids + colchicine

More general terms

• constrictive pericarditis
• pericardial effusion