|
May 2008
By Rajeev Garg, MD, Susan Cameron, BS, Niraj Mehta, MD, and Theodore E. Keats, MD
|
PROBLEM
A 63-year-old woman is referred from an outlying clinic for evaluation of lower extremity edema. She has a history of atrial fibrillation and preserved systolic function but denies having any complaints except fatigue and bilateral leg swelling of six months’ duration. During examination she was found to have an irregularly irregular pulse, jugular vein distension, right ventricular heave, audible early diastolic third heart sound suggestive of pericardial knock, clear lung fields, and a negative purified protein derivative test. What diagnosis does this chest x-ray suggest?
CLICK HERE FOR ANSWER |
|
ANSWER
This patient has constrictive pericarditis. Her chest x-ray shows calcification of the pericardium, left diaphragm, and indwelling bilateral breast prostheses (arrows), as well as an enlarged left atrium. Calcification on a chest x-ray is seen in only a small percentage of patients, and together with the above presentation, it should raise suspicion of pericarditis. Further evaluation with echocardiography and cardiac catheterization confirms the diagnosis. She should be referred to a cardiac surgeon for pericardiectomy.
|
Dr. Garg is a cardiology fellow at the University of Missouri in Columbia. Ms. Cameron is a medical student and Dr. Mehta is an associate professor of medicine at the University of Texas Health Science Center in Houston. This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, alumni professor of radiology at the University of Virginia School of Medicine in Charlottesville.
|
|
|
