Key result
Cardiac MRI identifies active constrictive pericarditis to guide medical therapy and defer pericardiectomy.
Why the study?
Chronic constrictive pericarditis is a rare but severe inflammatory disease of the pericardium that is often difficult to distinguish from restrictive cardiomyopathy without multimodality imaging.
Case Report (n=1)
No
Cardiac MRI with tissue characterization (LGE and T1/T2 mapping) can identify active, potentially reversible pericardial inflammation in chronic constrictive pericarditis, enabling targeted anti-inflammatory and antituberculous therapy to defer upfront surgical pericardiectomy.
Answers are grounded in this paper and cite their sources.
Cardiac MRI may detect reversible inflammation to defer pericardiectomy in select cases; hypothesis-generating for multimodality imaging in larger cohorts.
Chronic constrictive pericarditis (CCP), or Pick's syndrome, is a rare but severe inflammatory disease of the pericardium, often difficult to distinguish from restrictive cardiomyopathy without multimodality imaging. In sub-Saharan Africa, tuberculosis remains the leading cause. We report the case of a 37-year-old woman with a history of post-partum hypertension, admitted for a three-month history of exertional dyspnoea, lower-limb oedema and retrosternal chest pain in a febrile, tuberculosis-suggestive context. Examination revealed isolated right heart failure with a pericardial knock. Echocardiography and cardiac MRI showed pericardial thickening and circumferential detachment, bi-atrial dilatation and a septal bounce, with late gadolinium enhancement and T1/T2 mapping consistent with active pericardial inflammation, confirming an evolving, inflammatory form of CCP. Coronary CT angiography excluded coexisting coronary disease and revealed tuberculous pulmonary sequelae. Under corticosteroids, antituberculous therapy and symptomatic management, the patient improved clinically, allowing pericardiectomy to be deferred. This case highlights the value of cardiac MRI in the early diagnosis of inflammatory, potentially reversible forms of CCP, helping to avoid upfront surgery and guide targeted medical management, particularly in tuberculosis-endemic regions.
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Sall et al. (2026) conducted a case report in Chronic constrictive pericarditis (Pick's syndrome) (n=1). Cardiac MRI-guided medical management (corticosteroids and antituberculous therapy) was evaluated on Clinical improvement and deferral of pericardiectomy. Cardiac MRI diagnosed active inflammatory chronic constrictive pericarditis in a 37-year-old woman (n=1), guiding antituberculous and steroid therapy to defer pericardiectomy.
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