Liver cirrhosis cured by pericardectomy – a very rare case of non-calcifying constrictive pericarditis – case report and review of literature

Introduction: Constrictive pericarditis is a rare cause for heart failure. Symptoms resemble those of other causes, but patients do not respond accordingly to administered medication. The diagnosis is complicated and often those patients aquire diseases secondary to their heart failure.

Case report: We report a patient with recurrent pericardial and pleural effusions and ascites. The predominant clinical sign was dyspnea NYHA III-IV.

The detailled cardiologic examination showed right ventricular restriction, but no other pathological signs. The liver showed a sonographically cirrhotic structure, the CHILD classification was grade B. Liver cirrhosis was firstly classified as cryptogenous; the patient was referred to a transplantation center for liver transplant preparation. Cardiac Magnetic resonance imaging and computed tomography finally revealed a constrictive pericarditis as origin for liver cirrhosis. The patient was then scheduled for pericardectomy. Intraoperatively, the pericardium was thickened, but without typical calcifications.

Eight months after partial pericardectomy, functional and morphologic liver parameters were completely restored. The filling voluminas in MRI imaging increased significantly, EDV from 87 up to 111ml; the ESV from 21 up to 30ml; the stroke volume from 66 to 81ml.

There was no recurrence of ascites, pericardial or pleural effusions. Morphologic and functional cardiac imaging with computed tomography and angiography showed an absence of restriction and a complete normalization of ventricular volumes.

Conclusion: Non-calcifying constrictive pericarditis is very difficult to identify correctly in cardiac imaging. In cases of liver cirrhosis unknown cause, a constrictive pericarditis or a myocardial restriction has to be excluded as possible other causes by non-invasive cardiac imaging.