A 47-year-old woman was referred for evaluation of an 18-month history of progressive anorexia, fatigue, and dyspnea on exertion. She was unable to walk up seven steps in her split-level house without resting.
Physical examination was most remarkable for jugular venous distension. The chest radiograph (A) demonstrated a right pleural effusion and dense pericardial calcification. Simultaneous left (LV) and right (RV) ventricular filling pressures (C) revealed diastolic pressure elevation and early diastolic “dip and plateau” waveform, commonly referred to as the “square root sign.” The tracings are essentially superimposable throughout diastole. An intraoperative photograph (B) illustrates the densely calcified pericardium. The mean right atrial pressure decreased from 20 to 12 mm Hg at completion of partial pericardiectomy. Pathology and microbiology specimens were nondiagnostic. Eight months later she had complete resolution of symptoms and was able to complete 18 holes of golf, walking without difficulty.
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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