Constrictive Pericarditis Associated With a Mass Mimicking Pericardial Cyst

Abstract

Background: Constrictive pericarditis can be defined as a syndrome resulting from compression of the heart caused by rigid, thickened, and frequently fused pericardial membranes, and represents the end stage of any inflammatory process involving the pericardium. We present a rare case of chronic calcified constrictive pericarditis associated with a calcified mass mimicking pericardial cyst. Case Report: A 55-year-old man was admitted to our hospital due to shortness of breath, cough, chest pain, abdominal swelling, and edema of lower extremities. Computed tomography (CT) demonstrated a thickened calcified pericardium associated with a pericardial mass with a thick calcified shell (8x6x4.5 cm) compressing the right ventricle. Results of thoracic magnetic resonance imaging (MRI) were in compliance with the CT results. Based on these findings, a diagnosis of chronic calcified constrictive pericarditis associated with a pericardial cyst was made. At the time of surgery, extensive pericardial calcifications and a cystic mass containing only hematoma were found. The calcified pericardial sac was decorticated laterally at a level just above the course of the phrenic nerve on both sides. A pathological diagnosis of idiopathic constrictive pericarditis was made. The postoperative recovery was uneventful. Ten days after the operation, he was discharged in good condition. Conclusions: Presentation of constrictive pericarditis associated with a cystic mass consisted of hematoma and compressing the right ventricle is extremely rare but does occur. It should be operated on with CPB on standby, especially if erosion of the right ventricle has suspected.