Massive right pleural effusion and ascites caused by a primary constrictive pericardial band

Unilateral Transudative Pleural Effusion due to rare Cause – A Case Report

Transudative pleural effusions are characterized by low protein and lactate dehydrogenase according to Light’s criteria. Common causes are congestive cardiac failure, nephrotic syndrome, liver cirrhosis, and protein-losing enteropathy. Constrictive pericarditis is a rare cause of transudative pleural effusion. It can cause bilateral or unilateral recurrent effusions and chylothorax rarely. Common causes of constrictive pericarditis include infections such as viruses and tuberculosis, radiation, and cardiac surgery. We present a treated case of pulmonary tuberculosis presenting with massive, left-sided, and transudative pleural effusion due to constrictive pericarditis diagnosed by computed tomography scan and 2D echo with classical findings. Incidental findings were internal jugular vein thrombus and right lower lobar pulmonary embolus. This case highlights the atypical presentation of constrictive pericarditis as unilateral pleural effusion. A proper history with a high index of suspicion is essential in the workup of constrictive pericarditis which can be cured by pericardiectomy.

Pericardiectomy Using the Starfish Heart Positioner

We describe the use of the Starfish 2 heart positioning device as an aid to performing pericardiectomy for constrictive pericarditis. Whilst mainly a tool for off-pump coronary artery surgery, the Starfish device allows excellent cardiac positioning and haemodynamic stability during pericadiectomy via median sternotomy, without the need for cardiopulmonary bypass.