28 CONSTRICTIVE PERICARDITIS: A ROOM FOR MULTI-MODALITY IMAGING

Abstract Introduction The diagnosis of constrictive pericarditis can be challenging through conventional imaging. Novel imaging techniques have been proposed to improve it. Clinical Case A 74-year-old man with a previous heart failure preserved ejection fraction and permanent atrial fibrillation (AF) was admitted because worsening dyspnea, peripheral edema, ascites refractory diuretics therapy. ECG revealed low QRS voltages AF normal rate laboratory exams detected increased values BNP hepatic stasis indices; blood count CRP were normal. Echocardiography mildly reduced bi-ventricular pump function (left ventricular = 52%, right fractional area change 25%) slightly wall thickness. Atria moderately dilated atrium 46 44 ml/mq, respectively) mitral tricuspid annuli too. There inferior vena cava plethora, moderate atriogenic regurgitation mild-to-moderate regurgitation. paradoxical interventricular septal motion significant respiratory changes on trans-mitral (>25%) trans-tricuspid (>30%) pulsed Doppler noted; however, there no "annulus reversus" (lateral e’ 13 11 cm/sec, at TDI analysis. In contrast, 2D-speckle-tracking global longitudinal strain showed impaired deformation ​​of the lateral segments relative sparing segments. latter pattern has recently described as "strain or "hot septum sign". findings suspected pericarditis, but chest Computed Tomography excluded pericardial calcifications. Cardiac magnetic resonance (CMR) then performed revealing "septal shift" cine-real time sequences pericardium thickened (4-5 mm) widespread late gadolinium enhancement without signs acute inflammation T2-weighted Tricuspid confirmed "moderate" after phase-contrast catheterization finally coronary arteries (square root sign, equalization end-diastolic pressures). patient underwent pericardiectomy valve repair asymptomatic 6-months follow-up. Conclusions Constrictive represents potentially reversible cause easily missed present case, advanced echocardiography CMR essential come up an accurate diagnosis, guiding patient's clinical management excellent outcome.