Immunoglobulin G4-related constrictive pericarditis and the importance of a thorough workup: a case report

• DOI: 10.1186/s12872-022-02468-1
• Publication Date: 2022-02-04T16:13:28Z
• Authors: Sérgio Maltês; Margarida Cabral; Pedro Freitas; Catarina Albuquerque; Carolina Fernandes; Diana Moura; Beatriz Santos; Miguel Mendes; José Neves
• Keywords: Pericardiectomy; Cardiac catheterization; Transthoracic echocardiogram; Constriction

Abstract Background Constrictive pericarditis remains a problematic diagnosis and thorough investigation is critical. Among possible aetiologies, immunoglobulin-G4 (IgG4)-related pericardial disease an unusual cause of constriction. We report challenging diagnostic case constriction due to IgG4-related disease. Case presentation A 68-year old male with history inferior myocardial infarction right ventricle (RV) involvement was thrice-hospitalized marked ascites peripheral oedema. Systemic congestion initially attributed RV dysfunction previous infarction. Yet, at the final admission, re-assessment echocardiogram followed by cardiac computed tomography, magnetic resonance heart catheterization raised constrictive finding abnormal pulmonary venous return. Patient therefore underwent pericardiectomy surgical correction Pericardium histology revealed later discharged on corticosteroids symptomatic improvement. Conclusion rare pericardium while also presenting in everyday clinical practice. This exemplifies difficulties faced clinicians when reviewing pericarditis, highlighting importance multimodality assessment.