201. Breaking hearts and taking names: A case of sarcoidosis related effusive-constrictive pericarditis
- Author
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Matt Barnes, Ramon Valentin, John W. Petersen, Peter A. Drew, Divya Patel, George J. Arnaoutakis, Ali Ataya, Ellen C. Keeley, and Diana Gomez-Manjarres
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Constrictive pericarditis ,Cardiac Catheterization ,medicine.medical_specialty ,Sarcoidosis ,medicine.medical_treatment ,Pericardial effusion ,Pericardial Effusion ,03 medical and health sciences ,Pericarditis ,0302 clinical medicine ,Internal medicine ,Cardiac tamponade ,Humans ,Medicine ,030212 general & internal medicine ,Pericardiectomy ,Heart Failure ,business.industry ,Pericarditis, Constrictive ,Pericardial fluid ,medicine.disease ,Magnetic Resonance Imaging ,Cardiac Tamponade ,Pericardial window ,030228 respiratory system ,Echocardiography ,Cardiology ,Tamponade ,business - Abstract
Introduction Pericardial involvement of sarcoidosis is a rare cause for acute heart failure, and usually occurs as a result of the development of a pericardial effusion leading to cardiac tamponade. Even rarer still, is the manifestation of constrictive pericarditis. We report a case of sarcoidosis with lung, pleural, and pericardial involvement with effusive-constrictive pericarditis leading to cardiac tamponade. Case presentation A 34-year-old Caucasian man presented for evaluation of a history of worsening exertional dyspnea, edema, and weight loss. A high-resolution chest computed tomography showed diffuse pulmonary nodules with upper lobe predominance and in a perilymphatic distribution; large right pleural effusion; and large pericardial effusion with pericardial thickening. A transthoracic echocardiogram demonstrated early tamponade physiology for which a pericardial drain was placed. After removal of the drain he developed cardiogenic shock from cardiac tamponade attributed to the reaccumulation of a pericardial effusion and urgent pericardial window was performed. Serial echocardiography was concerning for organization and localization of the pericardial fluid. Cardiac magnetic resonance imaging demonstrated a significant reduction in pericardial slippage between the parietal and visceral layers around the heart collectively suggestive of constrictive pericarditis. Confirmation of effusive-constrictive pericarditis was noted on right heart catheterization. He then underwent pericardiectomy, which on histopathologic evaluation demonstrated non-necrotizing granulomas, thus confirming pericardial involvement of sarcoidosis. Conclusions We report a case demonstrating unique manifestations of sarcoidosis; effusive-constrictive pericarditis presenting with acute congestive heart failure.
- Published
- 2020