PMC8637386_01
Transverse CT thorax showing severely enlarged right atrium with large pericardial effusion.
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A 31-year-old man with history of hypothyroidism, hypertension, gout, and tobacco abuse, who presented with dyspnea on exertion for approximately 2 months as a transfer from an outside hospital after a computed tomography angiography of the chest showed 3.5 cm pericardial effusion and bi-atrial enlargement (Figure 1).
Echocardiogram done on first admission: (a) left ventricular inflow and (b and c) tissue doppler of myocardial velocities. (a) E deceleration time 132 ms, (b) e' lateral velocity 9.39 cm/s, and (c) e' septal velocity 4.36 cm/s.
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Echocardiogram showed an ejection fraction of 69%, moderately dilated left atrium and severely dilated right atrium, large pericardial effusion without tamponade physiology, dilated inferior vena cava with poor inspiratory collapse, dilated hepatic veins, mitral annular velocity (e') septal was 7.7 cm/s, e' lateral 9.39 cm/s, and E deceleration time 132 ms (Figure 2).
Echocardiogram done after pericardiectomy: (a) left ventricular inflow and (b and c) tissue doppler of myocardial velocities. (a) E deceleration time 60 ms, (b) e' lateral velocity 6.92 cm/s, and (c) e' septal velocity 4.36 cm/s.
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Echocardiogram showed e' septal 4.36 cm/s, e' lateral 6.92 cm/s, E deceleration time of 60 ms, and E/A ratio was 4.23 (Figure 3).
Cardiac MRI with and without contrast showing small ventricles with severe right atrial enlargement (a, b,c) and left atrial enlargement (d).
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Cardiac magnetic resonance images (CMRs) (Figure 4) showed bi-atrial enlargement, but signs of infiltrative disease could not be completely evaluated due to poor visualization of the myocardium on delayed post-contrast images.