Practice A Patient’s Journey

Constrictive pericarditis

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e3995 (Published 03 September 2012) Cite this as: BMJ 2012;345:e3995
  1. Ian Oliver, patient 1,
  2. Tom Treasure, professor 2
  1. 1A1 Haddington, East Lothian, UK
  2. 2A2 Clinical Operational Research Unit, Department of Mathematics, University College London, London WC1H 0BT, UK
  1. Correspondence to: I Oliver snowbird{at}ifb.co.uk
  • Accepted 23 January 2012

After progressing through several specialties, Ian Oliver was diagnosed with constrictive pericarditis. He underwent a successful pericardiectomy, but has been uncomfortable with subsequent drug treatment

In April 2010 I noticed that almost overnight I had developed a beer belly. As I do not drink much alcohol and am normally slim I began to worry. About this time I also became breathless and easily fatigued, and I developed swollen ankles caused by fluid retention. My general practitioner referred me to my local hospital for an ultrasound, which indicated that I had a swollen spleen and liver.

For the previous six years I had been under annual observation for a blood condition—originally described to me as myelodysplasia, but later identified as chronic myelomonocytic leukaemia. This condition did not cause me any discomfort, and I mention it only because I have been told that it can produce similar symptoms to constrictive pericarditis.

Initially, I was referred back to the consultant haematologist, who concluded that my condition was unlikely to be blood related. He referred me on to a cardiologist, who sent me for a series of tests and examinations over the succeeding months. These tests included the extraction of bone marrow, an angiogram, computed tomography and magnetic resonance imaging scans, and referral to a tropical medicine specialist, who in turn arranged for two tests to see if I had tuberculosis (QuantiFERON-TB Gold and Mantoux). Both these tests were negative.

The cardiologist eventually made a diagnosis of constrictive pericarditis, which he said was a rare condition that some doctors may not recognise. He also said that few data were available on this condition and that its cause was known in only 50% of cases, of which 15% were found to be tuberculosis related. Thereafter, I was referred to a specialist in respiratory medicine, who …

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