Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 5, Number 9, September 2014, pages 498-501

Constrictive Pericarditis: Rapid Progression of Pericardial Calcification in a Patient With Hemodialysis and Coronary Artery Bypass Surgery

Figures

Figure 1.
Figure 1. Electrocardiography shows normal sinus rhythm with inverted T in I, II, III, aVL, aVf, V3-6 leads.
Figure 2.
Figure 2. Chest radiography shows calcification on the posterior and inferior parts of the cardiac silhouette (arrow), with four wires fixing the sternum.
Figure 3.
Figure 3. Computed tomography on chest scan (axial view of posterior (upper) and diaphragmatic (lower) sides). Upper row: 2 years before admission (before initiation of hemodialysis) (left). One year before admission (2 months later after initiation of hemodialysis) (middle). At the time of admission (1 year later after initiation of hemodialysis) (right). Lower row: Pericardium was mostly not calcified 2 years before admission (left). Markedly calcified pericardium on the posterior (arrows) and diaphragmatic (arrow-heads) sides of the heart was revealed at the time of admission (right). It was notable the thickness of calcified pericardium was increased to approximately twice compared to 1 year before admission, 2 months later after initiation of hemodialysis (middle).

Table

Table 1. Data of Cardiac Catheterization Pre- and Post-Pericardiectomy
 
Pressure (mm Hg)PrePost
RA: right atrium; RV: right ventricle; PA: pulmonary artery; PCW: pulmonary capillary wedge; LV: left ventricle; Ao: aorta; a: a wave; v: v wave; m: mean pressure; s: systolic pressure; d: diastomic pressure; ed: end diastolic pressure. The preoperative hemodynamic measurements showed near equalization of diastolic pressure in all chambers and an early dip and plateau were seen in the pressure tracings of both ventricles. Pressure data obtained from cardiac catheterization at 3 weeks after pericardiectomy revealed hemodynamical improvement.
RA (a/v/m)18/16/154/2/1
RV (s/d/ed)59/12/2036/0/4
PA (s/d/m)56/23/2446/15/26
PCW (a/v/m)36/20/2518/19/15
LV (s/d/ed)147/11/22Not done
Ao (s/d/m)144/60/95Not done