ABSTRACT
Constrictive pericarditis (CP) is a disease primarily affecting the pericardial sac surrounding the heart. The constrictive physiology placed on the heart chambers can lead to clinical presentations mimicking heart failure and possibly primary liver disease. The diagnosis can often be missed and attributed to other etiologies until the patient undergoes extensive workup to rule out each potential etiology. Diagnosis can be delayed, leading to suboptimal outcomes and mortality rates. Here, we present a case of CP initially presenting with bilateral lower extremity and scrotal edema, initially attributed to alcoholic liver cirrhosis given the patient's history of alcohol abuse. Subsequent abdominal imaging found no evidence of cirrhosis, coupled with grossly normal echocardiogram that led to extensive workup and eventually the diagnosis of CP based on cardiac MRI. The patient later underwent pericardiectomy and made a full recovery. This case highlights the often ambiguous presentation of CP, the utility of cardiac MRI in diagnosis, and the need for specific criteria to help guide future diagnoses as imaging modalities continue to evolve.
ABSTRACT
Eosinophilic myocarditis (EM) is a rare type of myocarditis that can present acutely with rapidly progressing symptoms leading to high rates of morbidity and mortality. EM is defined by eosinophilic infiltration of the myocardium and can be difficult to diagnose even with gold-standard techniques, such as endomyocardial biopsy (EMB), given the possibility of patchy myocardial infiltration. Here, we present a case of idiopathic EM complicated by a cardiac arrest that was empirically treated with high-dose intravenous steroids after negative EMB. The patient's symptoms and cardiac function significantly improved after treatment. This case highlights the ambiguity of certain presentations of EM, its complications, and the importance of empiric treatment to avoid poor outcomes.