Constrictive Pericarditis Differential Diagnoses

Updated: Jan 01, 2020
  • Author: William M Edwards, Jr, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Diagnostic Considerations

The clinician must always keep constrictive pericarditis in the differential diagnosis of any patient who presents with unexplained dyspnea, gastrointestinal (GI) symptoms, ascites, or edema.

One of the more difficult distinctions to make is between constrictive pericarditis and restrictive cardiomyopathy. Because the physical findings may be identical, the physician must rely heavily on the patient’s history and other ancillary tests, including computed tomography (CT) scanning, magnetic resonance imaging (MRI), echocardiography, and invasive hemodynamic measurements.

Although still rare in absolute terms, sarcoidosis, amyloidosis, and hemochromatosis are the most commonly encountered infiltrative processes that lead to restrictive physiology. Cardiac fibrosis is another cause of restrictive cardiomyopathy that is becoming more frequent as cardiac patients with more common disorders live longer.

Systolic or diastolic congestive heart failure (CHF) from a number of causes, including pressure-overload and myocardial, valvular, or atherosclerotic disease, must be excluded.

Cardiac tamponade as a result of hemopericardium, uremia, or malignancy may mimic constrictive pericarditis. Distinguishing between the 2 conditions is critical.

Right-sided valvular abnormalities that increase venous pressure, such as tricuspid stenosis or tricuspid regurgitation, often have similar findings to constriction on physical examination. Echocardiography should readily identify these conditions.

Right-sided atrial tumors, such as myxomas, can mimic constriction by compressing the tricuspid valve. These are very rare and can be distinguished with echocardiography.

Superior vena cava syndrome and nephrotic syndrome can produce gross edema and ascites. Laboratory and imaging data should differentiate these from constriction.

Primary liver disease may present similarly to constriction and can be easily mistaken. Care should be taken to exclude a cardiogenic cause before attributing findings to cirrhosis (of other etiologies).

Ovarian carcinoma may be another consideration in patients with ascites and edema.

Differential Diagnoses