Constrictive pericarditis as a cause of refractory ascites after liver transplantation: A case report

[Imagen multimodal de la pericarditis constrictiva: reporte de un caso de cirrosis cardiaca]

Constrictive pericarditis is a rare cause of ascites and cardiac cirrhosis. We present the case of a 36-year-old male patient with a history of cirrhosis of unknown etiology, who consulted for refractory ascites, dyspnea, and lower limb swelling. Echocardiography determined constrictive pericarditis, which was corroborated by the findings of computed tomography. The clinical and hemodynamic worsening of the patient led to an emergency pericardiectomy with satisfactory recovery. This report shows a severe clinical consequence of constrictive pericarditis, cardiac cirrhosis, which was reversible with pericardial extirpation. Multimodal imaging was essential in the diagnosis of constrictive pericarditis.

A case report of constrictive pericarditis: a forgotten cause of refractory ascites

Constrictive pericarditis is well known but rare and commonly forgotten cause of ascites. Early diagnosis of constrictive pericarditis is difficult due to absence of typical cardiopulmonary signs and multiple vague symptoms and its insidious course. In this case report, we present, a 61-year-old male referred for liver transplantation vs transjugular intrahepatic portosystemic shunt work-up for presumptive diagnosis of nonalcoholic steatohepatitis cirrhosis and refractory ascites. Comprehensive work-up before liver transplantation including liver biopsy, liver ultrasound, and Doppler, magnetic resonance imaging was not consistent with liver cirrhosis. Echocardiographic was suggestive of constrictive pericarditis, further work-up with right heart catheterization, cardiovascular magnetic resonance and multidetector cardiac computed tomography confirmed the diagnosis of constrictive pericarditis. Patient underwent surgical pericardiectomy, he reminded stable after surgery and did not require further paracentesis and discharged in stable condition.