Constrictive pericarditis. Clinical clues to diagnosis

CONSTRICTIVE pericarditis is an uncommon condition that occurs in varied forms. Errors and uncertainties in diagnosis are frequent. Invasive studies and even exploratory thoracotomy are considered to be the only sure methods of diagnosis. Careful observation and correct interpretation of a number of clinical clues should, however, permit a correct clinical diagnosis in nearly all cases. Confusion With Noncardiac Disease Patients with constrictive pericarditis frequently receive diagnoses of and treatment for chronic liver disease, presumed abdominal carcinomatosis, or pleural effusion of suspected infectious or neoplastic cause. Why constrictive pericarditis has such a tendency to cause right pleural effusion, hepatomegaly, and ascites with little or no peripheral edema is not fully understood, but it is characteristic, particularly in young patients. However, this kind of diagnostic error would not be made if the neck veins were examined carefully in such patients. The central venous pressure is normal in liver disease and in