PMC5831313_01
Abdominal ultrasound. Bladder wall thickening (red arrow).
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Ultrasound examination showed fluid in the abdominal cavity together with bladder wall thickening (Figure 1), hepatomegaly, and pleural and pericardial effusion.
Computed tomography (CT scan). Fluid accumulation within the pericardium and abdomen (red arrows).
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Computed tomography confirmed all these findings (Figure 2).
Transthoracic echocardiography. Parasternal short axis view (apex) showing a large pericardial effusion (>5 cm) with a swinging heart. Pulse wave Doppler (PWD) examination shows significant respiratory variations (i.e., >25%) in left ventricular diastolic filling pattern.
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Hg without evidence of pulsus paradoxus. However, echocardiography showed a large pericardial effusion (>5 cm) with significant respiratory variations (i.e., >25%) of mitral inflow and inferior vena cava plethora (Figure 3).
Transthoracic echocardiography. Constrictive pericarditis. Pericardial thickening with fibrin deposits (14 mm), ventricular interdependence ("septal bounce"), and abnormal tissue Doppler imaging ("annulus paradoxus" and "annulus reversus").
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A new echocardiogram after 6 weeks showed an evolution to constrictive pericarditis (Figures 4 and 5).
Transthoracic echocardiography. Constrictive pericarditis. Pericardial thickening with a large amount of fibrin totally encasing the heart.
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A new echocardiogram after 6 weeks showed an evolution to constrictive pericarditis (Figures 4 and 5).
Transthoracic echocardiography. Almost complete resolution of the pericardial disease after 5 weeks of therapy with glucocorticoids.
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Last follow-up echocardiogram (three weeks later) showed an almost complete resolution of the pericardial disease with mild residual thickening of both layers and residual deposits of fibrin (Figure 6).