Carcinoid constrictive pericarditis

A 78 year old man presented with diarrhoea, anorexia, and progressive lower limb oedema. He was in atrial fibrillation and had a right pleural effusio n and ascites. Ultrasound of the abdomen and 24 hour urinary hydroxyindolea cetic acid output indicated metastatic carcinoid syndrome. Cardiac catheter isation revealed pericardial constriction, and pericardial exploration show ed a greatly thickened pericardium with no evidence of tumour invasion. The patient died within 24 hours of surgery. Necropsy findings were consistent with a diagnosis of constrictive pericarditis secondary to metastatic carc inoid syndrome.