Decreasing Liver Stiffness Following Pericardiectomy for Constrictive Pericarditis.

A 29-year-old man was admitted to our hospital for further examination of elevated liver enzymes, hepatosplenomegaly, thrombocytopenia and pericardial/pleural effusions. Fibroscan (EchoSens, Paris, France) and supersonic shear imaging (Aixplorer Supersonic Imagine, Aixen-Provence, France) revealed increased liver stiffness, consistent with cirrhosis (Picture A). A liver biopsy was performed and the histopathological findings revealed prominent centrilobular sinusoidal dilation with congestion (Picture B). Then, the patient was further evaluated for congestive liver disease and he was subsequently diagnosed with constrictive pericarditis. After radical pericardial stripping, his liver enzymes and liver stiffness dramatically decreased to within the normal values (Picture C). A few papers have reported that patients with heart failure have increased liver stiffness as measured by Fibroscan (1, 2), especially acute decompensated heart failure and right-sided heart failure (2). However, studies which include hepatic histopathological information are rare, and there are none that utilize supersonic shear imaging to measure and visualize tissue elasticity.