Constrictive Pericarditis Simulating Liver Disease in Children

Constrictive pericarditis, an uncommon disease of childhood, may disguise itself under many different manifestations, at times imitating primary liver disease. Three patients who were operated on at the Children's Memorial Hospital for nonspecific constrictive pericarditis were initially referred with the diagnosis of liver disease. In children with obscure liver enlargement and ascites, one should be suspicious of the presence of constrictive pericarditis as an etiologic factor, especially when associated with distended neck veins, a small heart, and low voltages and flat or inverted T waves on the electrocardiogram. The presence of calcifications around the heart is pathognomonic. Catheterization of the right side of the heart with measurement of intracardiac pressures and ventricular function is helpful in making the proper diagnosis and avoiding an unnecessary abdominal operation.