24654246 Visualization

A 30 Age - year Age - old Age woman Sex with a history of HIV Disease_disorder and HCV Disease_disorder presented Clinical_event to the emergency Nonbiological_location department Nonbiological_location with a 4 Duration - month Duration history of gradual Detailed_description but progressive Detailed_description swelling Sign_symptom of her lower Biological_structure limbs Biological_structure and abdomen Biological_structure .
She denied any chest Biological_structure pain Sign_symptom , dyspnoea Sign_symptom , paroxysmal Detailed_description nocturnal Detailed_description dyspnoea Sign_symptom or orthopnoea Sign_symptom .
Vitals Diagnostic_procedure were stable Lab_value .
Cardiovascular Diagnostic_procedure examination Diagnostic_procedure was remarkable for an elevated Lab_value jugular Diagnostic_procedure venous Diagnostic_procedure pressure Diagnostic_procedure ( JVP Diagnostic_procedure ) of about 12 Lab_value   cm Lab_value with a pronounced Lab_value ‘y’ Lab_value descent Lab_value .
There was a prominent Severity pericardial Sign_symptom knock Sign_symptom sound Sign_symptom heard over the praecordium Biological_structure .
There was no pericardial Sign_symptom rub Sign_symptom or murmur Sign_symptom .
The lungs Biological_structure were clear Lab_value to auscultation Diagnostic_procedure .
The patient was markedly oedematous Sign_symptom from the abdomen Biological_structure to the lower Biological_structure limbs Biological_structure .
She was admitted Clinical_event for further diagnostic Diagnostic_procedure work Diagnostic_procedure - up Diagnostic_procedure and management Therapeutic_procedure .
She was diagnosed with HIV Disease_disorder around May Date 2010 Date and had been on antiretroviral Medication therapy Medication .
She had not used illicit Activity drugs Activity for approximately Duration 5–6  years Duration .
Renal Disease_disorder and Disease_disorder hepatic Disease_disorder diseases Disease_disorder were ruled out through blood Diagnostic_procedure tests Diagnostic_procedure and imaging Diagnostic_procedure .
Peritoneal Biological_structure fluid Biological_structure was negative for malignancy Disease_disorder .
Echocardiogram Diagnostic_procedure showed a thickened Lab_value bright Lab_value pericardium Biological_structure adjacent to the right Biological_structure heart Biological_structure border Biological_structure (figure 1) with parallel Lab_value separation Lab_value between Lab_value epicardial Lab_value and Lab_value pericardial Lab_value echoes Lab_value (railroad track sign), septal Lab_value bounce Lab_value and lack of pericardial Lab_value slide Lab_value .
Annulus Sign_symptom paradoxus Sign_symptom was demonstrated on tissue Biological_structure Doppler Diagnostic_procedure (figure 2).
Left Diagnostic_procedure ventricular Diagnostic_procedure ejection Diagnostic_procedure fraction Diagnostic_procedure was 64% Lab_value .
The right Biological_structure ventricle Biological_structure was normal Lab_value in size Diagnostic_procedure and function Diagnostic_procedure .
There was moderate Severity tricuspid Sign_symptom regurgitation Sign_symptom .
There was no pericardial Sign_symptom effusion Sign_symptom , but the pericardial Biological_structure space Biological_structure was remarkable for debris Sign_symptom .
Constrictive Disease_disorder physiology Disease_disorder was demonstrated by Doppler Diagnostic_procedure study of tricuspid Other_event and Other_event mitral Other_event inflows Other_event (figure 3) during inspiration Activity and expiration Activity ; diastolic Sign_symptom flow Sign_symptom reversal Sign_symptom was also demonstrated in the hepatic Biological_structure veins Biological_structure during expiration Activity .
There was marked dilatation Sign_symptom of the inferior Biological_structure vena Biological_structure cava Biological_structure with no change during inspiration Activity or expiration Activity .
CT Diagnostic_procedure of the chest Biological_structure revealed thickening Sign_symptom of the pericardium Biological_structure with no evidence of calcification Sign_symptom .
There were no lung Biological_structure nodules Sign_symptom .
Bilateral Detailed_description pleural Disease_disorder effusions Disease_disorder and interstitial Detailed_description thickening Sign_symptom were present in the lung Biological_structure bases Biological_structure .
Cardiac Biological_structure MRI Diagnostic_procedure confirmed the presence of a diffusely Detailed_description thickened Sign_symptom pericardium Biological_structure at 5 Lab_value   mm Lab_value .
The inferior Biological_structure vena Biological_structure cava Biological_structure and hepatic Biological_structure veins Biological_structure appeared plethoric Sign_symptom .
There was a rapid Lab_value early Diagnostic_procedure diastolic Diagnostic_procedure filling Diagnostic_procedure and associated diastolic Sign_symptom septal Sign_symptom bounce Sign_symptom secondary to hindered Lab_value late Diagnostic_procedure diastolic Diagnostic_procedure filling Diagnostic_procedure (figure 4).
The patient showed a good Lab_value response Diagnostic_procedure to diuresis Therapeutic_procedure .
She underwent right Detailed_description and left Detailed_description heart Biological_structure catheterisation Therapeutic_procedure to confirm constrictive Disease_disorder physiology Disease_disorder .