Week 25
Return to Image Quiz Archive
Quiz 25 Context:
A 34-year-old male presents with complaints of nausea, malaise, and fatigue. The duration of these symptoms is difficult to determine; initially he complained of chronic low grade fevers and cough; subsequently constitutional symptoms have developed and they seem to have been present to some degree for several months but have clearly worsened over the past weeks. The patient has spent most of his life in sub-Saharan Africa and is visiting relatives in the United States. The patient has not had regular medical care, however history is reportedly negative for known chronic conditions.
Physical examination reveals a male patient in no acute distress. Vital signs reveal a temperature of 37.8 degrees Celsius, heart rate 68 bpm, blood pressure 126/68 mmHg. The exam is most notable for jugular venous distension, Kussmaul's sign, abdominal ascites, and 1+ peripheral edema.
A chest radiograph
is done and is shown above.
Sorry, that is not the most likely answer. Try Again.
d. Excellent!
This image reveals extensive pericardial calcifications on chest radiograph, in this case with pulmonary infiltrates due to tuberculosis. In the setting of this history and examination the correct choice is constrictive pericarditis.
You have correctly identified this week's Image of the Week. Now test your knowledge of other aspects of pericardial disease. Do you know…
…the significance of flattening of the left ventricular free wall, septal bounce, and inferior vena cava plethora with absent inspiratory collapse when evaluating for constrictive physiology? Which method of echocardiography is each associated? Which is more sensitive for the diagnosis of constrictive pericarditis- 2-D echo or doppler?
…the typical impact that constrictive pericarditis has upon end-diastolic pressure between cardiac chambers?
…the role of medical therapy in constrictive pericarditis? The percentage of patients with complete resolution of symptoms after pericardiectomy? What is the thirty-day perioperative mortality associated with pericardiectomy?
The answers to these questions, and a concise review of the pathogenesis, diagnosis, and treatment of pericardial disease, can be found here within the Cleveland Clinic Disease Management Project.
This history, examination, and chest film are most consistent with which of the following possibilities:
- Churg-Strauss syndrome
- Sarcoidosis
- Toxic shock syndrome
- Constrictive pericarditis
- Aspergillosis
