Misdiagnosis of constrictive pericarditis presenting with haemorrhagic pericardial effusion: a case report

Background The symptoms and signs of constrictive pericarditis (CP) are often elusive at onset, with a long symptom-free period that may take weeks to decades to develop after an episode of CP or pericardial injury, leading to a misdiagnosis. Case summary In this case, a 58-year-old man complained of lower extremity fatigue, intermittent chest tightness, and shortness of breath. He was first misdiagnosed as neuropathy, later unsuccessfully treated as ischaemic heart disease though severe stenosis of the diagonal branch of left anterior descending artery was confirmed by computer tomography angiography. He was finally diagnosed as CP after carefully reading the initial computed tomography. The gross pathology of heart in situ originally observed at the time of pericardectomy indicated fibrinous pericarditis, massive haemorrhagic pericardial effusion (300 mL), and thickened pericardium (maximum thickness more than 6mm). Following pericardial tissue biopsy, the histopathology showed chronic fibrinous pericarditis, without a clear aetiology. His symptoms gradually disappeared after surgical pericardectomy. At the 1-year follow-up visit, the patient complained of no discomfort. Discussion Constrictive pericarditis is one of the serious diseases commonly misdiagnosed. Computed tomography and echocardiography show the important diagnostic role in patients with CP, and surgical pericardectomy shows the potential in treating this disease, in some of which the mechanism underlying large haemorrhagic pericardial effusion remains unclear.