European Heart Journal Advance Access published July 18, 2015

CARDIOVASCULAR FLASHLIGHT

doi:10.1093/eurheartj/ehv313

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Myocardial herniation in constrictive pericarditis mimicking arrhythmogenic right ventricular cardiomyopathy Johannes Budjan1*, Dariusch Haghi2, Thomas Henzler1, and Theano Papavassiliu2 1

Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; and First Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

2

* Corresponding author. Email: [email protected]

A 51-year-old man presented with progressive exertional dyspnoea. After extensive external workup, he was referred to our hospital for further evaluation under the working diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC). Cardiac magnetic resonance imaging and computed tomography revealed thickening of the pericardium (Panels A, B, D, and F, white arrows) with an apical herniation of right ventricular (RV) myocardium (Panels A – D, arrow heads). Unlike apical aneurysms as found in ARVC, the herniated myocardium showed contraction in cardiovascular magnetic resonance imaging cine sequences (Panels A, B, C, and E) and associated trabeculae. Additionally, an atypical septal movement with diastolic bounce (Panel E), atrial enlargement (Panel B), and dilatation of inferior cava vein (not shown) were found. Cardiac catheterization demonstrated elevation and near equalization of left ventricular (LV), pulmonary capillary wedge, RV, and right atrial pressures (Panel G). The RV and LV pressure tracings showed a dip and plateau morphology and enhanced ventricular interdependence. These findings confirmed the diagnosis of constrictive pericarditis. The patient is planned for pericardiectomy. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].

Myocardial herniation in constrictive pericarditis mimicking arrhythmogenic right ventricular cardiomyopathy.

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