The patient is admitted to the hospital for further workup and treatment. After initial evaluation, a CT scan of the chest is obtained, an image of which is shown on the slide below. Which of the following is the most likely diagnosis?

Question

The patient is admitted to the hospital for further workup and treatment.  After initial evaluation, a CT scan of the chest is obtained, an image of which is shown on the slide below.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_3a87_c3eb_9249_57578c3cf821_MD0001_00 The above CT image shows thickening and calcification of the pericardium suggestive of constrictive pericarditis. Although the pericardium is normally only 1-2 mm thick, it can range in thickness from 4-20 mm in patients with constrictive pericarditis. Patients with this condition typically have slowly progressive dyspnea, chronic edema, and ascites. A rapid y-descent that becomes both deeper and steeper during inspiration is often observed on the jugular venous pressure tracing. Possible causes include radiation therapy to the chest, cardiac surgery, and tuberculosis (which is possibly the cause in this patient who is an immigrant from an endemic region). (Choice A) An aortic dissection causes sudden chest pain that radiates to the back. Chest radiographs often show widening of the mediastinum, and a double aortic lumen would be seen on a CT scan of the chest. (Choice C) Hypertrophic cardiomyopathy also presents with dyspnea and changes in the jugular venous pressure, specifically a prominent a wave. CT may show thickening of the interventricular septum but would not show thickening or calcification of the pericardium. (Choice D) Ischemic heart disease classically causes pressure like substernal chest pain that radiates to the left shoulder, and calcifications in the coronary arteries and aorta are often seen on CT. (Choice E) Patients with viral myocarditis have a variable clinical presentation ranging from asymptomatic to severe chest pain and cardiogenic shock. Pericardial thickening is not a feature of this condition. Educational objective: Calcification and thickening of the pericardium are common features of constrictive pericarditis on CT. Clinical findings include slowly progressive dyspnea, peripheral edema, and ascites.

The Patient Is Admitted to the Hospital for Further Workup