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IMAGES IN MEDICINE
Year : 2018  |  Volume : 31  |  Issue : 2  |  Page : 123

The heart in an eggshell


Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Date of Web Publication27-Feb-2019

Correspondence Address:
Narayanan Namboodiri
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-258X.253170


How to cite this article:
Gopalakrishnan A, Mohanan Nair KK, Namboodiri N, Valaparambil A. The heart in an eggshell. Natl Med J India 2018;31:123

How to cite this URL:
Gopalakrishnan A, Mohanan Nair KK, Namboodiri N, Valaparambil A. The heart in an eggshell. Natl Med J India [serial online] 2018 [cited 2021 Oct 24];31:123. Available from: http://www.nmji.in/text.asp?2018/31/2/123/253170



A 41-year-old woman presented with recent onset of abdominal distension and swelling of feet along with New York Heart Association Class III dyspnoea on exertion. Her blood pressure was 100/60 mmHg. The jugular venous waveforms were elevated till the angle of her jaw. The x-descent was conspicuous and the y-descent was visible. The precordium showed mild lateral systolic retraction. There was no pulmonary hypertension. ECG showed 1 mm ST depression and T inversion in inferolateral leads and no pathological Q waves. Chest X-ray revealed a radiopaque shadow around the heart [Figure 1]a. A plain CT scan of the chest showed the heart almost completely encased in a calcific shell [Figure 1]b. There was no history of tuberculosis. A diagnosis of calcific constrictive pericarditis was confirmed.[1] The coronary arteries were normal on angiography. A fluoroscopic projection at the time of coronary angiography before pericardiectomy revealed a characteristic black-egg sign (video available at www.nmji.in). The patient underwent surgical pericardiectomy with relief of symptoms and is doing well on follow-up. The use of plain anteroposterior fluoroscopic projection potentially permits a diagnosis of calcific constrictive pericarditis during coronary angiography without the need for a CT scan.
Figure 1: (a) Chest X-ray in posteroanterior projection showing a radiopaque shadow around the heart. Mild pulmonary venous congestion is evident. Distended superior vena cava is also seen, (b) Plain CT scan shows the heart almost fully encased in a calcific shell.
Video (available at www.nmji.in): Fluoroscopic projection in anteroposterior view showing a dark shadow encasing the heart (black-egg sign)


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Conflicts of interest. None declared

 
  References Top

1.
Kameda Y, Funabashi N, Kawakubo M, Uehara M, Hasegawa H, Kobayashi Y, et al. Heart in an eggshell: Eggshell appearance calcified constrictive pericarditis demonstrated by three-dimensional images of multislice computed tomography. Int J Cardiol 2007;120:269-72.  Back to cited text no. 1
    


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