A case of acute tuberculous pericarditis evolving into pericardial constriction after 32 years: A case report

A case of acute tuberculous pericarditis evolving into pericardial constriction after 32 years: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A case of acute tuberculous pericarditis evolving into pericardial constriction after 32 years: A case report EL KHADIR LOUBNA, Raynatou DJAFAROU BOUBACAR, HAMIDOU THIERNO DIALLO, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7586243/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Chronic constrictive pericarditis (CCP) is a rare condition. Pathophysiologically, it is characterized by inflammation and morphological changes of the pericardium leading to a presentation of adiastole. Etiologies are multiple, and tuberculosis remains a frequent cause in developing countries. Multimodal imaging has revolutionized the diagnosis of chronic constrictive pericarditis, and effective treatment remains pericardial decortication followed by etiological treatment whenever possible. Case presentation: We report the case of a 55-year-old female patient who presented with dyspnea and signs of right heart failure evolving in a context of asthenia. Transthoracic echocardiography and thoracic CT scan helped to diagnose chronic constrictive pericarditis, with tuberculosis as the suspected etiology based on the patient's history. The patient was initially treated medically, but due to persistent signs of systemic congestion, a diagnostic and therapeutic pericardial decortication was performed. Histopathological examination of the operative specimen confirmed Mycobacterium tuberculosis infection. Conclusion Chronic constrictive pericarditis is a rare but serious condition. Clinical presentation can vary from chronic fatigue to a refractory right-sided heart failure. Tuberculosis remains a relevant pathology in developing countries and should therefore always be suspected even in the context of previously treated tuberculosis. Pericardiectomy remains the gold standard in the effective management of this condition. Chronic Constrictive Pericarditis- Tuberculosis Pericardial Decortication Figures Figure 1 Figure 2 Figure 3 Figure 4 II. Introduction Chronic constrictive pericarditis (CCP) is a rare condition with a challenging diagnosis. In the literature, reported prevalence of constrictive pericarditis is around 0.02% of all cardiac diseases [ 1 , 2 ]. Pathophysiologically, it is characterized by inflammation of the pericardium and its transformation into a rigid, fibrocalcific, inextensible shell, thus forming a true casing enveloping both ventricles, leading to a hemodynamic picture of adiastole [ 2 , 3 ]. In the Western world, the main causes of chronic pericardial constriction are idiopathic or viral, followed by irritation after sternotomy and mediastinal radiotherapy. However, in developing countries and among immunocompromised patients, tuberculosis remains a major cause [ 4 ]. Early and clinical diagnosis remains difficult, hence the importance of multimodal imaging. Confirming the diagnosis of constrictive pericarditis is crucial as surgical intervention may be the only way to relieve symptoms. A normal pericardium has a thickness of less than 2 mm, and a thickness greater than 6 mm is specific for constriction [ 5 ]. III. Case report We report the case of a 55-year-old woman with no modifiable cardiovascular risk factors who presented to our emergency department with New York Heart Association (NYHA) stage III dyspnea evolving for six months, associated with fatigue and presyncope episodes. As past medical history, the patient was treated for acute tuberculous pericarditis in 1992. On admission, clinical examination revealed normal blood pressure (BP) and heart rate (HR) (BP = 117/70 mmHg, HR = 81 beats/min). Cardiovascular examination showed signs of right heart failure (jugular venous distention, hepatojugular reflux, ascites with bilateral lower limb edema), and a split second heart sound at the pulmonary area. Additionally, there were no signs of left heart failure. The electrocardiogram [Fig. 1 ] showed atrial fibrillation rhythm with an average ventricular rate of 83 beats per minute. Transthoracic echocardiography [Fig. 2 ] revealed a non-dilated, non-hypertrophied left ventricle with good overall contractility and presence of septal bounce. Left ventricular function was preserved at 66% by Simpson's Biplane method. The E-wave velocity was 90 cm/s with a short E-wave deceleration time (EDT) of 24 ms. Atrial chambers were dilated (left atrium surface area at 24 cm2, right atrium surface area at 22.3 cm2) with a calcified appearance of the pericardium. The right ventricle was non-dilated. The inferior vena cava was dilated at 26 mm, with a collapsibility index of less than 50%. The thoraco-abdominal CT scan revealed thoracic findings of cardiomegaly with diffuse pericardial thickening and calcifications [Fig. 3 ]. In the abdominal region, the liver was enlarged, exhibiting heterogeneous parenchymal enhancement with mosaic perfusion pattern, and there was significant ascites. In light of these signs, the diagnosis of chronic constrictive pericarditis was made. On the therapeutic front, the patient was started on Furosemide 250 mg/day, Spironolactone 75 mg/day, and therapeutic dose of Enoxaparin for her atrial fibrillation. Given the persistence of systemic congestion signs and significant functional impairment, the decision was made to proceed with surgical pericardial decortication. The patient underwent a beating-heart pericardiectomy. The intraoperative diagnosis supported chronic constrictive pericarditis, evidenced by the presence of thickened, calcified pericardium encasing the heart, which was rigid. The histopathological examination of the operative specimen revealed an infection with Mycobacterium tuberculosis, for which the patient was started on anti-tuberculous treatment with good clinical progress. IV. Discussion Chronic constrictive pericarditis results from chronic inflammation of the pericardium secondary to insults that can be associated with various etiologies, summarized non-exhaustively in Table 1 [ 6 ]. The prevalence of tuberculous origin chronic constrictive pericarditis is poorly understood but remains a common cause, particularly in developing countries [ 7 ]. Table 1 Causes of constrictive pericarditis Idiopatic or viral Postinfectious Tuberculosis or purulent pericarditis Bacterial, fungal, or parasitic Radiation exposure and neoplastic disease Postcardiac injury syndrome After cardiac surgery Post myocardical injury ( Dressler’s syndrome) Postpericardiotomy syndrome Connective tissue disease The main hemodynamic abnormality in constrictive pericarditis is characterized by the loss of pericardial compliance, leading to a dependence on elevated ventricular pressures to maintain adequate ventricular filling and cardiac output. These mechanisms collectively result in primary diastolic dysfunction [ 7 ]. The majority of patients present with a clinical picture of refractory right heart failure, notably jugular venous distention, which is always present due to venous hypertension, as well as hepatomegaly, lower limb edema, and ascites [ 8 , 9 ]. On the electrocardiogram, findings may include microvoltage, negative T waves, and atrial fibrillation (AF) [ 7 , 10 ], témoignant de l'augmentation de la pression dans les ventricules qui se transmet aux oreillettes à l’origine d’une dilatation atriale qui constitue le substrat anatomique de la FA. These clinical and electrical signs are not specific to constrictive pericarditis (CP), therefore the diagnosis unquestionably requires the contribution of multimodal imaging (echocardiography, cardiac CT scan, and sometimes cardiac MRI). The Mayo Clinic has defined echocardiographic criteria to suspect constrictive pericarditis, including abnormal septal motion related to respiration, normal or increased velocity of the medial mitral E' wave, and inversion of expiratory diastolic flow in the hepatic veins [ 11 ]. In a clinical presentation of adiastole, cardiac CT scan can reveal certain abnormalities such as pericardial thickening, presence of calcifications, atrial dilatation, dilatation of the vena cava, deformation of ventricular contours, as well as paradoxical septal motion [ 10 , 12 ]. Note that our patient exhibited significant pericardial calcifications on the CT scan, along with signs of hepatic venous congestion in the abdominal region. In patients with constrictive pericarditis (CP), MRI allows for the visualization of septal flattening, increased ventricular interdependence, and pericardial adhesions [ 13 ]. Right heart catheterization provides characteristic hemodynamic findings by demonstrating a typical pattern known as "dip-and-plateau" [Fig. 4 ]. This pattern indicates a normal pressure in the right ventricle during early diastole followed rapidly by an increase in pressure and then a meso- and telediastolic plateau [ 14 ]. The initial treatment relies on the use of diuretics to address volume overload. However, the only effective treatment for chronic constrictive pericarditis is pericardial decortication surgery [ 15 , 16 ]. V. Conclusion Chronic constrictive pericarditis is a rare but serious condition, most often manifested by a presentation of right heart failure. Tuberculous origin remains common, particularly in developing countries. While medical treatment can alleviate symptoms in some patients, pericardiectomy remains the gold standard in the effective management of this condition. Declarations Written informed consent was obtained from the patient for publication of this case report and any accompanying images. References Mambo NC (1981) Diseases of the pericardium: morphologic study of surgical specimen from 35 patients. Hum Pathol 12:978–978 Johnen J, Radermecker MA, Defraigne JO (2012) Le cas clinique du mois Péricardite constrictive. Rev Med Liège 67(3):107–112 Gournay G, Illouz E (1999) Péricardite chronique constrictive. EMC Cardiologie. Elsevier, Paris, p 15. [11-016-A-10] Depboylu BC, Mootoosamy P, Vistarini N, Testuz A (2017) Ismail El-Hamamsy, Mustafa Cikirikcioglu. Surg Treat Constrictive Pericarditis Tex Heart Inst J 44(2):101–106 Nauman Siddiqi MJ, Kern (2012) Patel. Asymmetric Focal Pericardial Thickening Causing Physiologically Significant Constrictive Pericarditis. Catheter Cardiovasc Interv 79:809–811 Ali Ataya JM, Cope D, Moguillansky TN, Machuca, Alnuaimat H (2016) A 61-Year-Old Man With Shortness of Breath, Ascites, and Lower Extremity Edema. Chest 149(6):e195–e199 Faisal F, Syed HV, Schaff, Jae K (2014) Oh. Constrictive pericarditis: A curable diastolic heart failure. Nat Rev Cardiol 11:530–544 Masud H, Khandaker RE, Espinosa RA, Nishimura LJ, Sinak SN, Hayes RM, Melduni, Jae K (2010) Oh; Pericardial Disease: Diagnosis and Management. Mayo Clin Proc. ;85(6):572–593 Onguema JRI, Raoul F, Marchais A et al (2023) Symptomatic atrial fibrillation revealing chronic constrictive pericarditis in a young patient: A case report with a review of the literature. Ann Cardiol Angeiol 72:101594 Talreja DR, Edwards WD, Danielson GK et al (2003) Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation 108:1852–1857 Terrence D, Welch JK, Oh (2017) Constrictive Pericarditis; Cardiol Clin 35:539–549 Bogaert J, Francone M (2013) Pericardial disease: value of CT and MR imaging. Radiology 267(2):340–356 Raissuni Z, Lachhab A, Haddour L, Doghmi N, Cherti M (2014) The role of multimodality imaging in the diagnosis of constrictive pericarditis. Ann Cardiol Angeiol 63(1):32–39 McManus BM, Bren GB102: 134–136., Adler Y, Charron P, Imazio M et al (1981). Hemodynamic cardiac constriction without anatomic myocardial restriction or pericardial constriction. Am Heart J. 2015 ESC Seidler S, Lebowitz D, Müller H (2015) Péricardite constrictive Chron Rev Med Suisse 11:1166–1171 Guidelines for the diagnosis (2015) and management of pericardial diseases: the task force for the diagnosis and management of pericardial diseases of the European society of cardiology (ESC)endorsed by: the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 36:2921–2964 Additional Declarations The authors declare no competing interests. Supplementary Files authordeclarationformFV.docx CONSENTEMENT Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7586243","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":513320648,"identity":"a6bcaa52-1795-4619-b581-17a3273b9adb","order_by":0,"name":"EL KHADIR 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fibrillation.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7586243/v1/77faf2bc8f1898922b1cc425.jpeg"},{"id":91512631,"identity":"44e411f7-0acd-43b7-8cc5-11c2f9a2a8e2","added_by":"auto","created_at":"2025-09-17 08:54:09","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":108601,"visible":true,"origin":"","legend":"\u003cp\u003eDoppler echocardiography revealing restrictive mitral inflow \u0026nbsp;velocity.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7586243/v1/f3b006310fcd4c0c010d4972.jpeg"},{"id":91511038,"identity":"8ca031b2-d389-4521-9903-9b0a23f06f4b","added_by":"auto","created_at":"2025-09-17 08:46:09","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":873490,"visible":true,"origin":"","legend":"\u003cp\u003eChest CT revealing cardiomegaly with diffuse pericardial thickening and calcifications.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7586243/v1/0451e7966c95c7501c1a1caf.jpeg"},{"id":91511041,"identity":"b58be429-92eb-4299-8b66-885196dd361f","added_by":"auto","created_at":"2025-09-17 08:46:09","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":343132,"visible":true,"origin":"","legend":"\u003cp\u003eThe \"dip-and-plateau\" aspect on right heart catheterization [14].\u003c/p\u003e\n\u003cp\u003eThe initial treatment relies on the use of diuretics to address volume overload. However, the only effective treatment for chronic constrictive pericarditis is pericardial decortication surgery [15,16].\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7586243/v1/90f6aac0df17eb772a172525.png"},{"id":91513443,"identity":"b7ad0af5-56f1-43c1-9b4f-4739cd74a556","added_by":"auto","created_at":"2025-09-17 09:02:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2056837,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7586243/v1/876cd308-bb93-4f6b-b89f-547b78440c8a.pdf"},{"id":91511033,"identity":"9ff42f86-2aa8-4ad0-807e-4c00753bb55f","added_by":"auto","created_at":"2025-09-17 08:46:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19882,"visible":true,"origin":"","legend":"\u003cp\u003eCONSENTEMENT\u003c/p\u003e","description":"","filename":"authordeclarationformFV.docx","url":"https://assets-eu.researchsquare.com/files/rs-7586243/v1/c207ac98676647396a91e7ab.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eA case of acute tuberculous pericarditis evolving into pericardial constriction after 32 years: A case report\u003c/p\u003e","fulltext":[{"header":"II. Introduction","content":"\u003cp\u003eChronic constrictive pericarditis (CCP) is a rare condition with a challenging diagnosis. In the literature, reported prevalence of constrictive pericarditis is around 0.02% of all cardiac diseases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Pathophysiologically, it is characterized by inflammation of the pericardium and its transformation into a rigid, fibrocalcific, inextensible shell, thus forming a true casing enveloping both ventricles, leading to a hemodynamic picture of adiastole [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the Western world, the main causes of chronic pericardial constriction are idiopathic or viral, followed by irritation after sternotomy and mediastinal radiotherapy. However, in developing countries and among immunocompromised patients, tuberculosis remains a major cause [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEarly and clinical diagnosis remains difficult, hence the importance of multimodal imaging. Confirming the diagnosis of constrictive pericarditis is crucial as surgical intervention may be the only way to relieve symptoms. A normal pericardium has a thickness of less than 2 mm, and a thickness greater than 6 mm is specific for constriction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e"},{"header":"III. Case report","content":"\u003cp\u003eWe report the case of a 55-year-old woman with no modifiable cardiovascular risk factors who presented to our emergency department with New York Heart Association (NYHA) stage III dyspnea evolving for six months, associated with fatigue and presyncope episodes. As past medical history, the patient was treated for acute tuberculous pericarditis in 1992.\u003c/p\u003e\u003cp\u003eOn admission, clinical examination revealed normal blood pressure (BP) and heart rate (HR) (BP\u0026thinsp;=\u0026thinsp;117/70 mmHg, HR\u0026thinsp;=\u0026thinsp;81 beats/min). Cardiovascular examination showed signs of right heart failure (jugular venous distention, hepatojugular reflux, ascites with bilateral lower limb edema), and a split second heart sound at the pulmonary area. Additionally, there were no signs of left heart failure.\u003c/p\u003e\u003cp\u003eThe electrocardiogram [Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e] showed atrial fibrillation rhythm with an average ventricular rate of 83 beats per minute.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTransthoracic echocardiography [Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e] revealed a non-dilated, non-hypertrophied left ventricle with good overall contractility and presence of septal bounce. Left ventricular function was preserved at 66% by Simpson's Biplane method. The E-wave velocity was 90 cm/s with a short E-wave deceleration time (EDT) of 24 ms. Atrial chambers were dilated (left atrium surface area at 24 cm2, right atrium surface area at 22.3 cm2) with a calcified appearance of the pericardium. The right ventricle was non-dilated. The inferior vena cava was dilated at 26 mm, with a collapsibility index of less than 50%.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe thoraco-abdominal CT scan revealed thoracic findings of cardiomegaly with diffuse pericardial thickening and calcifications [Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]. In the abdominal region, the liver was enlarged, exhibiting heterogeneous parenchymal enhancement with mosaic perfusion pattern, and there was significant ascites.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn light of these signs, the diagnosis of chronic constrictive pericarditis was made.\u003c/p\u003e\u003cp\u003eOn the therapeutic front, the patient was started on Furosemide 250 mg/day, Spironolactone 75 mg/day, and therapeutic dose of Enoxaparin for her atrial fibrillation. Given the persistence of systemic congestion signs and significant functional impairment, the decision was made to proceed with surgical pericardial decortication.\u003c/p\u003e\u003cp\u003eThe patient underwent a beating-heart pericardiectomy. The intraoperative diagnosis supported chronic constrictive pericarditis, evidenced by the presence of thickened, calcified pericardium encasing the heart, which was rigid.\u003c/p\u003e\u003cp\u003eThe histopathological examination of the operative specimen revealed an infection with Mycobacterium tuberculosis, for which the patient was started on anti-tuberculous treatment with good clinical progress.\u003c/p\u003e"},{"header":"IV. Discussion","content":"\u003cp\u003eChronic constrictive pericarditis results from chronic inflammation of the pericardium secondary to insults that can be associated with various etiologies, summarized non-exhaustively in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe prevalence of tuberculous origin chronic constrictive pericarditis is poorly understood but remains a common cause, particularly in developing countries [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCauses of constrictive pericarditis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIdiopatic or viral\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostinfectious\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eTuberculosis or purulent pericarditis\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBacterial, fungal, or parasitic\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRadiation exposure and neoplastic disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostcardiac injury syndrome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAfter cardiac surgery\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePost myocardical injury ( Dressler\u0026rsquo;s syndrome)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePostpericardiotomy syndrome\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConnective tissue disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe main hemodynamic abnormality in constrictive pericarditis is characterized by the loss of pericardial compliance, leading to a dependence on elevated ventricular pressures to maintain adequate ventricular filling and cardiac output. These mechanisms collectively result in primary diastolic dysfunction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe majority of patients present with a clinical picture of refractory right heart failure, notably jugular venous distention, which is always present due to venous hypertension, as well as hepatomegaly, lower limb edema, and ascites [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOn the electrocardiogram, findings may include microvoltage, negative T waves, and atrial fibrillation (AF) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], t\u0026eacute;moignant de l'augmentation de la pression dans les ventricules qui se transmet aux oreillettes \u0026agrave; l\u0026rsquo;origine d\u0026rsquo;une dilatation atriale qui constitue le substrat anatomique de la FA.\u003c/p\u003e\u003cp\u003eThese clinical and electrical signs are not specific to constrictive pericarditis (CP), therefore the diagnosis unquestionably requires the contribution of multimodal imaging (echocardiography, cardiac CT scan, and sometimes cardiac MRI).\u003c/p\u003e\u003cp\u003eThe Mayo Clinic has defined echocardiographic criteria to suspect constrictive pericarditis, including abnormal septal motion related to respiration, normal or increased velocity of the medial mitral E' wave, and inversion of expiratory diastolic flow in the hepatic veins [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn a clinical presentation of adiastole, cardiac CT scan can reveal certain abnormalities such as pericardial thickening, presence of calcifications, atrial dilatation, dilatation of the vena cava, deformation of ventricular contours, as well as paradoxical septal motion [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNote that our patient exhibited significant pericardial calcifications on the CT scan, along with signs of hepatic venous congestion in the abdominal region.\u003c/p\u003e\u003cp\u003eIn patients with constrictive pericarditis (CP), MRI allows for the visualization of septal flattening, increased ventricular interdependence, and pericardial adhesions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRight heart catheterization provides characteristic hemodynamic findings by demonstrating a typical pattern known as \"dip-and-plateau\" [Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e]. This pattern indicates a normal pressure in the right ventricle during early diastole followed rapidly by an increase in pressure and then a meso- and telediastolic plateau [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe initial treatment relies on the use of diuretics to address volume overload. However, the only effective treatment for chronic constrictive pericarditis is pericardial decortication surgery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e"},{"header":"V. Conclusion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eChronic constrictive pericarditis is a rare but serious condition, most often manifested by a presentation of right heart failure. Tuberculous origin remains common, particularly in developing countries. While medical treatment can alleviate symptoms in some patients, pericardiectomy remains the gold standard in the effective management of this condition.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMambo NC (1981) Diseases of the pericardium: morphologic study of surgical specimen from 35 patients. Hum Pathol 12:978\u0026ndash;978\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohnen J, Radermecker MA, Defraigne JO (2012) Le cas clinique du mois P\u0026eacute;ricardite constrictive. Rev Med Li\u0026egrave;ge 67(3):107\u0026ndash;112\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGournay G, Illouz E (1999) P\u0026eacute;ricardite chronique constrictive. EMC Cardiologie. Elsevier, Paris, p 15. [11-016-A-10]\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDepboylu BC, Mootoosamy P, Vistarini N, Testuz A (2017) Ismail El-Hamamsy, Mustafa Cikirikcioglu. Surg Treat Constrictive Pericarditis Tex Heart Inst J 44(2):101\u0026ndash;106\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNauman Siddiqi MJ, Kern (2012) Patel. Asymmetric Focal Pericardial Thickening Causing Physiologically Significant Constrictive Pericarditis. Catheter Cardiovasc Interv 79:809\u0026ndash;811\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli Ataya JM, Cope D, Moguillansky TN, Machuca, Alnuaimat H (2016) A 61-Year-Old Man With Shortness of Breath, Ascites, and Lower Extremity Edema. Chest 149(6):e195\u0026ndash;e199\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFaisal F, Syed HV, Schaff, Jae K (2014) Oh. Constrictive pericarditis: A curable diastolic heart failure. Nat Rev Cardiol 11:530\u0026ndash;544\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasud H, Khandaker RE, Espinosa RA, Nishimura LJ, Sinak SN, Hayes RM, Melduni, Jae K (2010) Oh; Pericardial Disease: Diagnosis and Management. Mayo Clin Proc. ;85(6):572\u0026ndash;593\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOnguema JRI, Raoul F, Marchais A et al (2023) Symptomatic atrial fibrillation revealing chronic constrictive pericarditis in a young patient: A case report with a review of the literature. Ann Cardiol Angeiol 72:101594\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTalreja DR, Edwards WD, Danielson GK et al (2003) Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation 108:1852\u0026ndash;1857\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTerrence D, Welch JK, Oh (2017) Constrictive Pericarditis; Cardiol Clin 35:539\u0026ndash;549\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBogaert J, Francone M (2013) Pericardial disease: value of CT and MR imaging. Radiology 267(2):340\u0026ndash;356\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaissuni Z, Lachhab A, Haddour L, Doghmi N, Cherti M (2014) The role of multimodality imaging in the diagnosis of constrictive pericarditis. Ann Cardiol Angeiol 63(1):32\u0026ndash;39\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcManus BM, Bren GB102: 134\u0026ndash;136., Adler Y, Charron P, Imazio M et al (1981). Hemodynamic cardiac constriction without anatomic myocardial restriction or pericardial constriction. Am Heart J. 2015 ESC\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeidler S, Lebowitz D, M\u0026uuml;ller H (2015) P\u0026eacute;ricardite constrictive Chron Rev Med Suisse 11:1166\u0026ndash;1171\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuidelines for the diagnosis (2015) and management of pericardial diseases: the task force for the diagnosis and management of pericardial diseases of the European society of cardiology (ESC)endorsed by: the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 36:2921\u0026ndash;2964\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Hôpital Ibn Sina-Rabat","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic Constrictive Pericarditis- Tuberculosis, Pericardial Decortication","lastPublishedDoi":"10.21203/rs.3.rs-7586243/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7586243/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eChronic constrictive pericarditis (CCP) is a rare condition. Pathophysiologically, it is characterized by inflammation and morphological changes of the pericardium leading to a presentation of adiastole. Etiologies are multiple, and tuberculosis remains a frequent cause in developing countries. Multimodal imaging has revolutionized the diagnosis of chronic constrictive pericarditis, and effective treatment remains pericardial decortication followed by etiological treatment whenever possible.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e\u003cp\u003eWe report the case of a 55-year-old female patient who presented with dyspnea and signs of right heart failure evolving in a context of asthenia. Transthoracic echocardiography and thoracic CT scan helped to diagnose chronic constrictive pericarditis, with tuberculosis as the suspected etiology based on the patient's history. The patient was initially treated medically, but due to persistent signs of systemic congestion, a diagnostic and therapeutic pericardial decortication was performed. Histopathological examination of the operative specimen confirmed Mycobacterium tuberculosis infection.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eChronic constrictive pericarditis is a rare but serious condition. Clinical presentation can vary from chronic fatigue to a refractory right-sided heart failure. Tuberculosis remains a relevant pathology in developing countries and should therefore always be suspected even in the context of previously treated tuberculosis. Pericardiectomy remains the gold standard in the effective management of this condition.\u003c/p\u003e","manuscriptTitle":"A case of acute tuberculous pericarditis evolving into pericardial constriction after 32 years: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 08:46:04","doi":"10.21203/rs.3.rs-7586243/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"707420c8-c883-4e3a-97dc-4b762643eba3","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-17T08:46:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 08:46:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7586243","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7586243","identity":"rs-7586243","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}