case_images: PMC11177727_01
case_images: Cardiac magnetic resonance imaging showing diffused thickening of the pericardium with delayed gadolinium enhancement.
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case_images: The MRI demonstrated diffuse thickening of the pericardium with increased enhancement on delayed myocardial enhancement and an adequate ventricular ejection fraction of 45% (Figure 1).
case_images: Panel A. 2D echocardiography, parasternal short axis view showing respiratory related septal shift. Panel B. Shows a dilated inferior vena cavae of 2.33 cm with less than 50% respiratory variation. Panel C and D. Tissue Doppler imaging demonstrated higher medial than lateral early diastolic annulus velocities (17.1 cm/s and 14.6 cm/s, respectively). Evidence of annulus reversus.. Panel E. Speckle tracking imaging, global longitudinal strain was -19% (Normal range: -16% to -22%).
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case_images: A repeat echocardiogram revealed a septal bounce with annulus reversus and a plethoric IVC; the GLS was -19 (Figure 2), findings suggestive of CP.
case_images: Panel A. Right heart catheterization showing "dip and plateau" or "square root sign" Panel B. Right heart catheterization shows equalization of diastolic pressures pulmonary capillary wedge pressure of 26, left ventricle pressure of 24, right ventricle pressure of 23, and right atrium pressure of 26. Left ventricle and right ventricle tracing with ventricular discordance.
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case_images: A right heart catheterization provided evidence of equalization of end-diastolic pressures, the "dip and plateau" sign, and ventricular discordance consistent with CP (Figure 3).
case_images: Hematoxylin & Eosin stain with thickened fibrotic pericardium with hemosiderin-laden macrophages and eosinophils.
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case_images: The patient underwent a pericardiectomy, and pathology revealed a thickened fibrotic pericardium with focal mild long-term inflammation and many hemosiderin-laden macrophages (Figure 4).