Cardiac sarcoidosis presenting as constrictive pericarditis

• Published in: Texas Heart Institute journal Vol. 41; no. 3; pp. 319 - 323
• Main Authors: Darda, Saba, Zughaib, Marcel E, Alexander, Patrick B, Machado, Christian E, David, Shukri W, Saba, Souheil
• Format: Journal Article
• Language: English
• Published: United States Texas Heart® Institute, Houston 01-06-2014
• Subjects: Biopsy; Cardiac Catheterization; Cardiomyopathies - complications; Cardiomyopathies - diagnosis; Cardiomyopathies - physiopathology; Cardiomyopathies - surgery; Case Reports; Hemodynamics; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive - diagnosis; Pericarditis, Constrictive - etiology; Pericarditis, Constrictive - physiopathology; Pericarditis, Constrictive - surgery; Pleural Effusion - etiology; Predictive Value of Tests; Recovery of Function; Recurrence; Sarcoidosis - complications; Sarcoidosis - diagnosis; Sarcoidosis - physiopathology; Sarcoidosis - surgery; Treatment Outcome; pericarditis, constrictive/complications/etiology/surgery; sarcoidosis/complications/diagnosis/pathology; myocardium/pathology; diagnosis, differential; Cardiomyopathies/complications/diagnosis/pathology; treatment outcome; diagnostic imaging
• ISSN: 0730-2347; 1526-6702
• DOI: 10.14503/THIJ-13-3208

In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association. We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient's clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient's case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.