An unusual cause of refractory ascites with cirrhosis


  • Nikhil Mehra Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
  • Poonam Sherwani Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India



Chronic constrictive pericarditis, Pericardial calcification, Refractory ascites, Tuberculosis


Reports of chronic constrictive pericarditis presenting with hepatomegaly, cirrhosis and ascites but no cardiac symptoms are rare. A 10 year old child presented with refractory ascites and firm hepatomegaly of 2 years duration which partially responded to diuretics. Doppler study showed dilated hepatic veins and inferior vena cava and ruled out hepatic venous outflow tract obstruction. Chest X ray showed pericardial calcification and 2D Echo was suggestive of chronic constrictive pericarditis. A diagnosis of chronic calcified constrictive pericarditis with cirrhosis and refractory ascites was made. Based on previous series which showed that tuberculosis is the most common cause of constrictive pericarditis, tuberculosis as the cause of constrictive pericarditis was kept. Anti tuberculous treatment as per Revised National Tuberculosis Control Program guidelines was started along with oral steroids and diuretics. Child showed response to the treatment and was later referred to cardiac surgery department for further management (pericardectomy).  


Yuan SM. Refractory ascites as the only presenting symptom of chronic calcified constrictive pericarditis: a diagnostic challenge. Heart Surg Forum. 2014;17(1):42-6.

Merwe S, Dens J, Daenen W, Desmet V, Fevery J. Pericardial disease is often not recognised as a cause of chronic severe ascites. J Hepatol. 2000;32(1):164-9.

Little WC, Freeman GL. Pericardial disease. Circulation. 2006;113:1622-32.

Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol. 2004;43(8):1445-2.

Gautam MP, Gautam S, Sogunuru G, Subramanyam G. Constrictive pericarditis with a calcified pericardial band at the level of left ventricle causing mid-ventricular obstruction. BMJ Case Rep; 2012.