skip to main content

Transient Constrictive Pericarditis — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardPericardial DiseaseTransient Constrictive PericarditisEECC

A 50-year-old man presents with constrictive pericarditis. He has markedly elevated JVP with a prominent y descent, hepatomegaly, ascites, and peripheral oedema. CMR shows pericardial thickening (5 mm) with late gadolinium enhancement of the pericardium. CRP is elevated at 35 mg/L. What does the pericardial LGE and elevated CRP suggest about potential treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Active pericardial inflammation; a trial of anti-inflammatory therapy (NSAIDs, colchicine, ± corticosteroids) before pericardiectomy is warranted, as transient constrictive pericarditis may be reversible

Constrictive pericarditis may be classified as: (1) transient/reversible — active inflammation causing constriction that resolves with anti-inflammatory treatment; (2) chronic/irreversible — fibrotic/calcific constriction requiring pericardiectomy. Pericardial LGE on CMR indicates active inflammation, and when combined with elevated inflammatory markers (CRP, ESR), suggests the constriction may be at least partially reversible (transient constrictive pericarditis). The 2025 ESC Guidelines recommend a trial of anti-inflammatory therapy (2-3 months) before committing to pericardiectomy in patients with evidence of ongoing inflammation. If constriction persists despite medical therapy, pericardiectomy is indicated. This distinction is crucial because pericardiectomy carries significant operative mortality (5-10%).

Reference: ESC (2025): Guidelines for Myocarditis and Pericarditis