Constrictive Pericarditis

A 69-year-old woman with a 3-year history of exertional dyspnea presented with signs of volume overload. Her occupational asbestos exposure history had previously resulted in focal pleural plaques. Chest radiography revealed circumferential pericardial calcification, interstitial edema, and bilateral pleural effusions. CT imaging confirmed extensive pericardial calcification. Transthoracic echocardiography showed preserved ejection fraction with septal bounce and expiratory diastolic flow reversal in the hepatic vein. Simultaneous right and left heart catheterization demonstrated ventricular interdependence and pressure discordance, typical of constrictive pericarditis: during inspiration, right ventricular pressure peaked while left ventricular pressure decreased, reversing with expiration. The “square root” sign indicated early rapid ventricular filling followed by abrupt cessation in diastole. A diagnosis of constrictive pericarditis secondary to asbestosis was made. Pericardiectomy resolved symptoms, and tissue analysis ruled out tuberculosis. The patient remained well at 2-year follow-up.

A 69-year-old woman with a 3-year history of exertional dyspnea presented with signs of volume overload. Her occupational asbestos exposure history had previously resulted in focal pleural plaques. Chest radiography revealed circumferential pericardial calcification, interstitial edema, and bilateral pleural effusions. CT imaging confirmed extensive pericardial calcification. Transthoracic echocardiography showed preserved ejection fraction with septal bounce and expiratory diastolic flow reversal in the hepatic vein. Simultaneous right and left heart catheterization demonstrated ventricular interdependence and pressure discordance, typical of constrictive pericarditis: during inspiration, right ventricular pressure peaked while left ventricular pressure decreased, reversing with expiration. The “square root” sign indicated early rapid ventricular filling followed by abrupt cessation in diastole. A diagnosis of constrictive pericarditis secondary to asbestosis was made. Pericardiectomy resolved symptoms, and tissue analysis ruled out tuberculosis. The patient remained well at 2-year follow-up.