Constrictive pericarditis at abdominal CT: A commonly overlooked diagnosis

Background: The purpose of this study was to evaluate findings at abdominal computed tomography (CT) in patients with proven constrictive pericarditis. Methods: The medical records of 25 patients with surgically proven constrictive pericarditis and abdominal CT examinations within 30 days of operation were reviewed. Clinical symptoms, laboratory findings and prospective CT findings were collated. The CT examinations were also retrospectively reviewed in an unblinded fashion. Results: Direct CT findings of constrictive pericarditis with an abnormal pericardium were present in 23/25 patients. Only 9 of 25 (36%) patients were detected prospectively. Findings on retrospective review included pericardial calcification (10/25, 40%) or thickening (13/25, 52%), dilated IVC (20/25), dilated hepatic veins (14/25), ascites (14/25), mesenteric soft tissue stranding (12/25), mottled enhancement of the hepatic parenchyma (8/25), and cirrhosis (6/25). Anemia was present in (17/25), and an elevated AST levels occurred in 48% (12/25) of patients. The most common abdominal symptoms were pain (4/12), diarrhea (4/12), distention (3/12), and bloating (1/12). Conclusions: Constrictive pericarditis can present with vague abdominal symptoms. Anemia and elevated liver function tests are common laboratory abnormalities. Indirect CT findings of dilated IVC and/or hepatic veins, ascites, or cirrhosis should prompt inspection of the pericardium. In the majority of cases an abnormal pericardium could be identified (thickened, calcified or both).