Q: 32 year  old male from South Africa and with history of tuberculosis in his teen who migrated to USA 5 years back presented with  chest pain and shortness of breath. Patient was initially admitted to ICU with concern of cardiac tamponade due to clinical finding of  pulsus paradoxus. STAT ECHO showed  mild pericardial effusion, and patient continue to have clinical signs consistent with pericarditis and pericardial effusion?


Answer: Effusive constrictive pericarditis

Commonly found in southern Africa and presents frequently in patients with history of tuberculous pericarditis  is difficult to distinguish from constrictive pericarditis. Despite little effusion and despite lowering the pericardial pressure to normal, elevated right atrial pressure persists with Y dominance and impaired respiratory variation. This is due to the fact that the pericardial cavity is  obliterated, and very little coexisting pericardial effusion can manifest cardiac tamponade physiology, despite lowering the pericardial pressure to normal. It is hard to diagnose due to mix findings. 


 Reference: 

 Sagristà-Sauleda J, Angel J, Sánchez A, et al. Effusive-constrictive pericarditis. N Engl J Med 2004; 350:469.