Korean Circ J.  2009 Mar;39(3):116-120. 10.4070/kcj.2009.39.3.116.

A Case of Constrictive Pericarditis Associated With Huge Epicardial Fat Volume

• Do GW
• Ku BS
• Park CS
• Kim SJ
• Shin ES
• Choi SH
• Lee SG

• KMID: 1825969
• DOI: http://doi.org/10.4070/kcj.2009.39.3.116

Abstract

Massive deposits of fat around heart are seen in overweight persons and are associated with coronary artery disease. Investigators have focused on the clinical significance of epicardial fat with respect to metabolic effects such as insulin resistance and inflammation, but the mechanical effects, such as constriction, have been largely ignored. We present an unusual case of a 59-year-old woman with obesity and diabetes mellitus who had been undergoing peritoneal dialysis due to end-stage renal disease, and who developed constrictive pericarditis, possibly secondary to extensive epicardial fatty accumulation.

Keyword

Epicardium; Fat; Pericarditis, constrictive; Echocardiography; Tomography, spiral computed; Heart catheterization

MeSH Terms

Cardiac Catheterization
Constriction
Coronary Artery Disease
Diabetes Mellitus
Echocardiography
Female
Heart
Humans
Inflammation
Insulin Resistance
Kidney Failure, Chronic
Middle Aged
Obesity
Overweight
Pericarditis, Constrictive
Pericardium
Peritoneal Dialysis
Research Personnel
Tomography, Spiral Computed

Figure

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  Fig. 1 Chest radiography showed an enlarged cardiac silhouette and obliteration of both costophrenic angles indicating the presence of a pleural effusion.

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  Fig. 2 Initial two-dimensional transthoracic echocardiogram in parasternal view (A) and apical four chamber view (B) showed a small pericardial effusion (arrow), a diffuse and circumferential echogenic mass in the epicardium (arrowhead). Transmitral pulsed-wave Doppler signals (C) showed prolongation of the deceleration time and no significant respiratory variations which were not compatible with constrictive pericarditis. Ejection fraction of LV was estimated to be 68%. LV: left ventricle, LA: left atrium.

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  Fig. 3 Follow-up two-dimensional transthoracic echocardiogram showed decreased pericardial effusion, pericardial thickening and adhesion (arrow) (A and B), and inferior vena cava plethora (C). Doppler showed respiratory variations in the transmitral inflow (D) and hepatic vein reversal (E). On tissue Doppler imaging, the average pulsed Doppler-derived E' velocity at the septal corner was 5 m/s (F). The respirometer signal was very poor, and this might have been caused by obesity. I: inspiration, E: expiration.

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  Fig. 4 Multislice computed tomography of the heart showed thickened pericardium and diffuse, extensive fat infiltration of the whole pericardium, with a density similar to that of fat (approximately -40 Hounsfield units) (*). A: oblique sagittal section. B: oblique coronal section. C: axial section.

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  Fig. 5 Cardiac catheterization. A: cardiac catheterization on simultaneous RV and LV pressure tracings showed equalization of diastolic pressure, as well as a "dip and plateau" feature. B: cardiac catheterization on simultaneous RA and LV pressure tracings showed equalization of RA and LV pressures and marked x & y descent on RA pressure. LV: left ventricle, RA: right atrium, RV: right ventricle.

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