A Rare Case of Constrictive Pericarditis

Figures

• 

  Figure 1. Baseline and Post-Pericardiectomy Transthoracic Echocardiogram and Cardiac Magnetic Resonance Imaging Baseline transthoracic echocardiogram demonstrating septal bounce and respirophasic shift on M-mode (A), respiratory variation across mitral valve (B), tricuspid valve inflows (C), Tissue Doppler imaging demonstrating annulus reversus (D, E), and increased hepatic vein expiratory diastolic flow reversal compared to forward diastolic flow (F). Baseline CMR showing respirophasic shift with septal flattening on inspiration (G) and normal motion on expiration (H). Postpericardiectomy imaging showing resolution of constrictive findings on echocardiography and CMR (I to P).

• 

  Figure 2. Baseline Chest Computed Tomography Chest CT axial image (A) showing mediastinal mass (arrowhead). Chest CT axial (B) and sagittal (C) images showing pericardial thickening with small pericardial fluid.

• 

  Figure 3. Post-Pericardiectomy Histopathology of Pericardial Specimen (A) Low-power examination of morphology demonstrates loose fascicles of bland fibroblasts and myofibroblasts (×20, hematoxylin and eosin). (B) On high-power examination, the lesional cells show elongated tapered cytoplasm with bland nuclei and inconspicuous nucleoli without cytologic atypia or increased mitotic activity (×40, hematoxylin and eosin). (C) Smooth muscle actin highlights the lesional cells in a tram-track pattern, consistent with myofibroblastic differentiation (×40, smooth muscle actin).