A case of massive general edema due to constrictive pericarditis which was hard to diagnose

A 66-year-old man was admitted to our hospital due to massive general edema and shortness of breath. Several physicians he visited previously carried out examinations including catheterization, but failed to clarify the cause of the edema. After admission, collagen disease, renal disease, and some other possible disorders were excluded. Right heart failure was obvious on admission and was rapidly getting worse day by day. The patient's body weight increased from 80 kg to 94 kg in 30 days despite sufficient diuretics. Cardiac catheterization exhibited a dip and plateau pattern of the right ventricular pressure wave form and highly elevated right ventricular systolic pressure. This led to the diagnosis of constrictive pericarditis. Cardiolysis surgery was performed, followed by an excellent postoperative clinical course. His weight dropped from 94 kg to 60 kg at discharge which is his standard weight. This case suggests that in the case of unidentified right heart failure, constrictive pericarditis should be taken into consideration as a differential diagnosis.