Liver transplantation and constrictive pericarditis

We report the case of a patient with refractory ascitis due to a constricti ve pericarditis who underwent a liver transplantation with the initial diag nosis of cryptogenic cirrhosis. The cardiac origin was suspected 5 months p ost surgery when a liver biopsy showed lesions in favor of a post sinusoida l shunt. The diagnosis was confirmed by the increased values of the right i ntra-ventricular pressures. We discuss the causes of the delay of the diagn osis and, in particular, the difficulty to interpret vascular liver lesions . Such vascular lesions were present on the needle biopsy performed prior t o transplantation but wrongly interpreted as cirrhosis.