Korean Circ J.  2015 Jul;45(4):333-336. 10.4070/kcj.2015.45.4.333.

Constrictive Pericarditis Long after a Gunshot Wound

• Choi JH
• Uhm JS
• Lee SE
• Chun KH
• Lee HJ
• Lee SH
• Hong GR
• Lee MH

• KMID: 1964106
• DOI: http://doi.org/10.4070/kcj.2015.45.4.333

Abstract

Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium. Etiology of the constriction can occur for many reasons. Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period. A 69-year-old patient with atrial flutter was admitted to the hospital. A cardiac computed tomography showed a bullet located adjacent to the right atrium. The transthoracic echocardiography showed a thickened pericardium and septal bouncing motion, which were compatible with constrictive pericarditis. The history of the patient revealed an injury by gunshot during the Korean War in 1950. Radiofrequency ablation of the atrial flutter was performed, and after ablation, the bullet was removed surgically. The patient was discharged home after surgery without complications.

Keyword

Foreign body reaction; Pericarditis, constrictive; Atrial flutter

MeSH Terms

Aged
Atrial Flutter
Catheter Ablation
Constriction
Echocardiography
Foreign Bodies
Foreign-Body Reaction
Heart Atria
Humans
Korean War
Pericarditis, Constrictive*
Pericardium
Wounds, Gunshot*

Figure

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  Fig. 1 Chest X-ray shows a bullet adjacent to the right cardiac border and bilateral pleural effusion.

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  Fig. 2 Electrocardiography shows a typical atrial flutter with 2-to-1 atrioventricular conduction.

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  Fig. 3 Computed tomographic images confirm that the bullet is located in the epicardial fat. A: axial image. B: long axis image. C: three-dimensional volume-rendered image.

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  Fig. 4 Pulsed-wave Doppler image reveals significant respiratory variation of the mitral inflow velocity.

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  Fig. 5 The bullet (arrow) in the surgical field.

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  Fig. 6 Hyalinized degeneration (arrows) of the pericardial tissue (hematoxylin-eosin stain, ×100).

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