Late onset radiation-induced constrictive pericarditis and cardiomyopathy after radiotherapy

Figure 1. A, Electrocardiogram showed sinus rhythm, lower voltage of limb leads, QTc prolongation (508 ms) and ST-T segment changes on leads II, III, aVF, and V4 through V6. B, Transthoracic echocardiogram revealed marked respiratory variation that was a 34% increase of mitral E velocity during expiration. C, Lateral Mitral annular movement that assessed on tissue Doppler imaging showed diastolic velocities (Em) was at lower normal limit (11 cm/s).

Figure 2. A, The 4-chamber view of CMR demonstrated biatrial enlargement. B, A small amount of pericardial effusion and thickened pericardial layers were seen. B, C, There was LGE-MRI of biventricular subendocardial part walls and mid-myocardial layer consistent with fibrosis. CMR = cardiac magnetic resonance, LGE = late gadolinium enhancement, MRI = magnetic resonance imaging.

Figure 3. A, During the surgery a segment of pericardium was resected (7.0 × 4.5 × 0.5 cm). B, Histological examination with hematoxylin and eosin (H&E) staining revealed chronic fibrinous pericarditis (×100). C, Some white tough tissue were partly in place of from biventricular endocardium to myocardium section nearby epicardium which was clarified as focal interstitial fibrosis in H&E staining (×100). D, Electron microscope demonstrated that increasing quantity of mitochondrial, lipofuscin, and lipid droplet of myocardial cells without cellular necrosis, some mitochondrial swelled and ridge disappeared as well as vacuolar degeneration.