Presentation
The patient has a history of right upper quadrant pain, jaundice, ascites, and difficulty in breathing on and off.
Patient Data
There is irregular, thick, and extensive calcification involving the anterior, left, and infero-basal portions of the pericardium.
This is a non-contrast study. There is no pleural effusion seen; however, the proximal-most part of the inferior vena cava just before it drains into the right atrium is dilated, which is suggestive of retrograde flow due to pericardial constriction.
Case Discussion
Pericardial calcification may occur secondary to a wide variety of inflammatory insults ranging from viral infections, uremia, and pericarditis, which usually result in a thinner, eggshell pattern of calcification, compared to more aggressive inflammatory conditions such as TB, in which thick, confluent, and irregular calcification may be seen.
The presence of pericardial calcification is not diagnostic of constrictive pericarditis and may be an asymptomatic incidental finding. However, in this case, the clinical features and IVC dilatation are in keeping with significant cardiac constriction. Constrictive pericarditis is often misdiagnosed as liver disease.
The normal pericardial thickness on the CT scan should be less than 2 mm 1.
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