PMC9207951_01
Cardiac computed tomography shows bilateral pleural effusion and a calcified pericardium (red arrows).
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F1
Cardiac CT showed a calcified pericardium (Figure 1).
Ultrasonography shows decreased cardiac function underlying protein-losing enteropathy. (A) M-mode ultrasonography shows thickening of the posterior pericardium of the posterior wall of the left ventricle and signs of a septal notch. The left ventricular ejection fraction is 77%. (B) The posterior pericardium of the posterior wall of the left ventricle is thickened (thickness, 7 mm). (C) Pulse Doppler shows limited ventricular diastolic activity. The high peak E and low peak A result in an E/A of >2. (D) A four-chamber view of the heart shows marked thickening of the pericardium and atrial enlargement. (E) The inferior vena cava is greatly widened (width, 26 mm). (F) Myocardial relaxation is normal.
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F2
Echocardiography showed decreased cardiac function underlying protein-losing enteropathy (PLE; Figure 2).
Anterior plane abdominal scintigraphy at 10 min and 1, 2, 3, 6, and 24 h after intravenous administration of technetium-99m-labeled human serum albumin. Tracer accumulation in large vessels, heart blood pool, liver, and kidney is present at 10 min and 1 h. Tracer accumulation in the abdomen is not present at 10 min and 1 h. Tracer accumulation in the lower abdomen is vaguely observed at 2 and 3 h (red circles). A large amount of tracer accumulation is present in the right lower abdomen at 6 h, and the radionuclide shows the bowel. Clear colonic tracer accumulation is present at 24 h.
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F3
Functional imaging with technetium-99m serum albumin identified the region of protein leakage as the intestine (Figure 3).
Pathological examination of the pericardium shows hyaline degeneration (red arrow).
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F4
A pathological examination of the pericardium showed hyaline degeneration (Figure 4).
Clinical course of the patient. Serum albumin concentrations are improved after pericardiectomy.
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F5
His serum albumin concentrations were increased (3.3-3.7 g/dL), which indicated resolution of the PLE (Figure 5).