Dyspnea in a Patient with Ascites
A 71-year-old man presented to our hospital with a one-month history of worsening dyspnea (NYHA 3), lower limb edema, and abdominal distension. A computerized tomography (CT) scan showed the presence of ascites and a cirrhotic appearing liver. Physical exam revealed normal vital signs, elevated jugular venous pulse, a distended abdomen, and 3+ pedal edema. Electrocardiogram and chest x-ray were unremarkable. Inflammatory markers were unremarkable with a normal C-reactive protein of (0.32 mg/dL). Initial echocardiogram findings are shown in Figures 1-3.
Subsequently, the patient underwent a simultaneous left and right cardiac catheterization (Figure 4) and subsequently a cardiovascular magnetic resonance imaging (CMR) (Figure 5).
T2 weighted image with fat saturation (middle): Global hyperintense pericardium suggestive of edema.
Late gadolinium enhancement-fat saturation (right): Global hyperintense pericardium suggestive of active inflammation.
What is the clinical diagnosis and best next step in management?