The absence of mediastinal shift in the presence of unilateral pleural effusion is a notable physical and radiological finding in patients with constrictive pericarditis and mediastinitis.
May flag constrictive pericarditis when unilateral effusion lacks mediastinal shift; hypothesis-generating from case reports and requires validation.
We are reporting six patients with constrictive pericarditis and mediastinitis who demonstrate clinical and radiological absence of mediastinal shift in the presence of unilateral pleural effusion. This obvious physical finding has undoubtedly been noted in some of the numerous reports of constrictive pericarditis. However, we have been unable to discover such reference in an extensive review of the literature. If this finding has been previously reported, it bears reemphasis. The importance of an accurate diagnosis of constrictive pericarditis before irreversible myocardial, hepatic, and pulmonary complications have taken place has been well emphasized by Dalton, 1 White, 2 Schmeiden, 3 Beck 4,5 and others. Tuberculosis is the most common etiological factor in this disease, being present in 5% to 20% of reported series, 6-12 while other infectious diseases account for an additional 5% to 10%. No definitive etiological factor is apparent in the remainder. The usual symptomatology includes: weakness, dyspnea, orthopnea, abdominal enlargement, and, occasionally,
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Richard T. Beebe (1960) studied this question.
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