# A cursed duet—a case of tuberculous effusive-constrictive pericarditis

## TL;DR

This paper presents a rare case of tuberculous effusive-constrictive pericarditis in a 34-year-old patient requiring surgery after standard treatments failed.

## Contribution

The novelty lies in demonstrating the complex hemodynamics of ECP through a case requiring pericardiectomy despite pericardiocentesis.

## Key findings

- ECP was diagnosed using echocardiography before and confirmed by catheterization after pericardiocentesis.
- The patient required pericardiectomy due to persistent right heart failure symptoms.
- The case highlights the rare clinical entity of ECP and its management challenges.

## Abstract

Effusive constrictive pericarditis (ECP) is a syndrome of combined pericardial effusive and constrictive physiology. Historically, it was a rare diagnosis which required invasive cardiac catheterisation confirmation post drainage of the pericardial effusion. However, the emergence of reliable echocardiographic features of constrictive disease has improved diagnostic yield.

We present a case of a 34-year-old patient with a pericardial effusion secondary to tuberculous pericarditis which demonstrated constrictive features on echocardiogram pre-pericardiocentesis and on invasive cardiac catheterisation measurements post pericardiocentesis – consistent with ECP. Ultimately this patient required a pericardiectomy for refractory symptoms of right heart failure despite pericardiocentesis.

We utilise this case to highlight the rare clinical entity of ECP but also to demonstrate the complex haemodynamics which govern pericardial effusions, constrictive pericarditis and ECP.