What's the most likely diagnosis?

• 47 year-old with dyspnea

1. Restrictive cardiomyopathy
2. Constrictive pericarditis
3. Asbestos-related pleural disease
4. Sarcoidosis
5. Mesothelioma

Answer:

 

2. Constrictive pericarditis

 

 

More (Click Discussion Tab)

Constrictive pericarditis

General considerations

• Defined by thickening of pericardium (>4mm) impeding diastolic filling
• Thickened pericardium may calcify (50%)
• Calcified pericardium almost always implies constriction, but not always
• About 50% of calcified pericardiums are visible on conventional radiography
• Calcification of the pericardium is most likely inflammatory in nature
  • Can be seen with a variety of infections, trauma, and neoplasms
  • Most common causes include
    • Viral pericarditis (most common)
    • Tuberculous pericarditis
    • Uremic pericarditis
    • Post-cardiac surgery
• Calcification most commonly occurs along the inferior diaphragmatic surface of the pericardium surrounding the ventricles
  • Thin, egg-shell like calcification is more often associated with viral infection or uremia
  • Calcification from old TB is often thick, confluent, and irregular in appearance, especially when compared with myocardial calcification

 

More ...