PMC5067788_01
Electrocardiogram showing sinus tachycardia with low voltage complexes particularly of limb leads. There are no significant ST-T changes.
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ECG showed sinus tachycardia with low voltage complexes (Fig. 1).
(A-D) 2D echocardiography showing thickened pericardium with mild circumferential pericardial effusion in parasternal long axis view (A); M-mode echocardiography revealed septal bounce (arrow) with thickened pericardium and mild pericardial effusion (B). Zoomed 4 chamber view (C) showed thickened pericardium (4.7 mm) and subcostal view (D) showing dilated inferior vena cava non-collapsing with respiration.
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Echocardiography was suggestive of effusive constrictive pericarditis such as >50% variations of Doppler velocities, thickened pericardium, dilated inferior vena cava, noncollapsing with respiration (Fig. 2, Fig. 3).
(A-D) Midline sternotomy revealed thickened pericardium (A), which was dissected using electro cautery and blunt dissection using fingers (B and C). Pericardium was thickened and firmly adherent to underlying epicardium with areas of fibrosis and calcifications (D).
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She underwent total pericardiectomy through midline thoracotomy, pericardium was grossly thickened, adherent to sternum and myocardium (Fig. 4A-D).