Premium
A case of refractory bilateral pleural effusion due to post‐irradiation constrictive pericarditis
Author(s) -
YAMAMOTO NATSUO,
NODA YOSHIAKI,
MIYASHITA YOSHIHIRO
Publication year - 2002
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1046/j.1440-1843.2002.00414.x
Subject(s) - medicine , constrictive pericarditis , transudate , pericardiectomy , cardiac catheterization , cardiology , pericarditis , pleural effusion , ventricle , restrictive cardiomyopathy , pericardial effusion , surgery , heart failure , pericardium , cardiomyopathy , pleural fluid
A 51‐year‐old woman suffering from dyspnoea and refractory bilateral pleural effusions is discussed. The effusion was characterized as a transudate and cardiac decompensation and renal insufficiency were initially suspected. Diuretic agents were not effective and the patient required bilateral chest water‐sealed drainage tubes for 4 months, after exclusion of neoplastic infiltration, collagen disease and other cardiac disorders. On echocardiogram, cardiac function and other findings were almost normal, except for shortening of deceleration time in transmitral flow velocity. To evaluate the reduced diastolic compliance, cardiac catheterization was performed, and revealed an elevated pressure in the right ventricle with a dip‐and‐plateau pattern, and constrictive pericarditis was diagnosed. The hydrothorax resolved after pericardiectomy and symptoms were alleviated. Three and a half years after surgery, the patient is well and taking only oral diuretics. The underlying mechanism of cardiac disorder appears to have been mixed restriction and constriction due to irradiation of her chest for breast cancer 13 years ago. Because the echocardiogram was within normal limits, the diagnosis was delayed. Radiation‐induced constrictive pericarditis should be considered if there is an unexplained transudate effusion with a normal echocardiogram.