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May 1960

Constrictive Pericarditis: Absence of Mediastinal Shift in the Presence of Unilateral Pleural Effusion

Author Affiliations

Albany, N.Y.

From the Department of Medicine, Albany Medical College and Albany Hospital, Albany, N.Y.

AMA Arch Intern Med. 1960;105(5):755-757. doi:10.1001/archinte.1960.00270170093011

We are reporting six patients with constrictive pericarditis and mediastinitis who demonstrate clinical and radiological absence of mediastinal shift in the presence of unilateral pleural effusion. This obvious physical finding has undoubtedly been noted in some of the numerous reports of constrictive pericarditis. However, we have been unable to discover such reference in an extensive review of the literature. If this finding has been previously reported, it bears reemphasis.

The importance of an accurate diagnosis of constrictive pericarditis before irreversible myocardial, hepatic, and pulmonary complications have taken place has been well emphasized by Dalton,1 White,2 Schmeiden,3 Beck 4,5 and others.

Tuberculosis is the most common etiological factor in this disease, being present in 5% to 20% of reported series,6-12 while other infectious diseases account for an additional 5% to 10%. No definitive etiological factor is apparent in the remainder.

The usual symptomatology includes: weakness, dyspnea, orthopnea, abdominal enlargement, and, occasionally,

Dalton, J. C.; Pearson, R. J., Jr., and White, P. D.:  Constrictive Pericarditis: Review and Long-Term Follow-Up of 78 Cases ,  Ann. Int. Med. 45:445, 1956.Crossref
White, P. D.:  Chronic Constrictive Pericarditis (Pick's Disease) Treated by Pericardial Resection ,  Lancet 2:539, and 597, 1935.
Schmeiden, V., and Westermann, H. H.:  The Operative Management of Fibrous Constricting Pericarditis ,  Surgery 2:350, 1937.
Beck, C. S.:  Acute and Chronic Compression of the Heart ,  Am. Heart J. 14:515, 1937.Crossref
Beck, C. S., and Griswold, R. A.:  Pericardiectomy in the Treatment of the Pick Syndrome ,  Arch. Surg. 21:1064, 1930.Crossref
Burwell, C. S., and Blalock, A.:  Chronic Constrictive Pericarditis: Physiology and Pathologic Considerations ,  J.A.M.A. 110:265, 1938.Crossref
Andrews, G. W. S.; Pickering, G. W., and Sellors, T. H.:  The Etiology of Constrictive Pericarditis with Specific Reference to Tuberculous Pericarditis Together with a Note on Polyserositis ,  Quart. J. Med. 17:291, 1948.
Auerbach, O.:  Pleural, Peritoneal, and Pericardial Tuberculosis ,  Am. Rev. Tuberc. 61:845, 1950.
Burwell, C. S., and Ayer, G. D.:  Constrictive Pleuritis and Pericarditis ,  Am. Heart J. 22:267, 1941.Crossref
Harrington, S. W., and Barnes, A. R.:  Diagnosis and Surgical Treatment of Chronic Constrictive Pericarditis ,  Southern Surg. 9:459, 1940.
Herrmann, G. R.; Marchand, E. J.; Greer, G. H., and Mancik, M. R.:  Pericarditis: Clinical and Laboratory Data of 130 Cases ,  Am. Heart J. 43:641, 1952.Crossref
Wolfe, L. I.:  An Autopsy Study of the Diseases of the Pericardium ,  Permanente Found. M. Bull. 8:122, 1950.
Schwartz, G.:  Case Reports ,  Wein. Klin. Wchnschr. 23:1823, 1910.
Dieuaide, F. R.:  The Electrocardiogram as an Aid in the Diagnosis of Adhesive Pericardial Mediastinitis ,  Arch. Int. Med. 35:362, 1925.Crossref
Armstrong, T. G.:  Adherent Pericardium: Constrictive and Nonconstrictive ,  Lancet 2:475, 1940.Crossref
Chambliss, J. R., and others:  Chronic Cardiac Compression (Chronic Constrictive Pericarditis) ,  Circulation 4:816, 1951.Crossref
Freidberg, C. K.:  Diseases of the Heart , Philadelphia, W. B. Saunders Company, 1956.
Billings, F. T., Jr., and Couch, O. A., Jr.:  Pericardial Calcification and Histoplasmin Sensitivity ,  Ann. Int. Med. 42:654, 1955.Crossref