The July issue of the Journal of General Internal Medicine has a case report of constrictive pericarditis presenting as protein-losing enteropathy. This is one of many deceptive presentations of constrictive pericarditis which have been reported including liver disease, Budd Chiari Syndrome, refractory pleural effusions, chylous ascites, chylothorax, and lymphopenia with hypogammaglobulinemia. These unusual manifestations are, in one way or another, consequences of systemic venous hypertension.
Clinically, constrictive pericarditis looks a lot like restrictive cardiomyopathy. Differentiation between the two has been difficult, but is crucial, as constrictive pericarditis is surgically treatable if diagnosed early. Recent advances in echocardiography and cardiac doppler have improved the diagnostic approach which is outlined in this review. The distinction can be made with echo-doppler but it is operator dependent, requiring a focused approach with detailed attention to the respiratory cycle. This isn’t the type of information you’re likely to get from a routine echo report unless you tell the technician exactly what you’re looking for.