Analysis of the clinical manifestations and diagnostic process of the pleural effusion associated with constrictive pericarditis

Objectives : Constrictive pericarditis is one of the rare causes of pleural effusion and is easily misdiagnosed and missed clinically, precisely due to the non-specific clinical features of constrictive pericarditis. Methods : In this study, we conducted a retrospective analysis of 19 cases of pathologically confirmed constrictive pericarditis. These patients were admitted to our hospital between January 2019 and December 2022 after pericardial stripping. The collected data included imaging findings, clinical manifestations, pleural effusion characteristics, postoperative pathology, and the diagnostic process. Results : In this study, the age of the 19 patients ranged from 25 to 74 years, with a median age of 59 years. The duration of the disease varied from 20 days to 24 months, with a median duration of 4 months. All patients presented with bilateral pleural effusion, with or without pericardial lesions such as pericardial effusion or thickening. Pleural effusion biochemistry did not exhibit specific characteristics, and both etiology and pleural pathology were negative. Radiographic examinations, including cardiac ultrasound and chest CT, revealed signs of pericardial thickening and/or pericardial effusion or no abnormalities. Pericardial stripping was performed in all patients, and the postoperative pathology confirmed various degrees of thickened pericarditis, consistent with constrictive pericarditis. During a follow-up period of 6-18 months, most patients (17 out of 19) showed favorable recovery with no recurrence of bilateral pleural effusion. Conclusions: In patients presenting with bilateral pleural effusion and pericardial lesions, the possibility of constrictive pericarditis should be considered. CT and cardiac ultrasound play a significant role in its diagnosis, while pericardial stripping serves as a confirmatory diagnostic method and an effective treatment approach.