Pericardial disease is often not recognised as a cause of chronic severe ascites

Background/Aims: Severe chronic ascites remains a difficult diagnostic and therapeutic problem. Even in the current era, constrictive pericarditis is an under-estimated and sometimes unrecognised cause. Moreover, missing the diagnosis deprives patients of remedial therapy, Methods: Two cases of calcified constrictive pericarditis, complicated with cirrhosis and diagnosed in a late stage, are described. Due to insufficien t clinical appreciation and lack of trust in echocardiography features perf ormed by cardiologists who were insufficiently familiar with the echocardio graphic features of constrictive pericarditis, diagnosis was delayed in. th e two patients. Results: The diagnosis of constrictive pericarditis as a cause of ascites i s based upon the clinical signs of right heart failure in a patient with no rmal systolic left and right ventricular function and a high, serum-ascitic albumin-content difference. Complementary workup with complete Doppler ech ocardiography study, right and left heart catheterisation and MRI or cine C T of the heart is necessary to confirm the diagnosis. Conclusion: Careful history taking and clinical examination remain the corn erstone of any diagnostic work-up, even in this era of technological refine ment.