Correct!
5. All of the above

Although she has a diagnosis of pericarditis, acute pericarditis does not fit her clinical picture. She does not have any chest pain and her symptoms have persisted for some time. CT scans of her chest and abdomen and an echocardiogram are indicated because of her symptoms and physical findings and a cardiac origin seems likely as the origin. Her routine laboratory is remarkable for a hemoglobin of 12.2 gm/dL, hemoglobin A1C 8.3%, and a random blood sugar of 180 mg/dL.

Thoracic CT shows a thickened and calcified pericardium with a small right pleural effusion. Abdominal CT shows peritoneal fluid with splenomegaly and uterine fibroids. The cardiac ultrasound shows:

• Findings consistent with constrictive pericarditis. Thickened and calcified pericardium, especially posterior.
• Normal left ventricular chamber size (low normal). Calculated ejection fraction 52%. Normal right ventricular size with mildly reduced systolic function.
• Estimated right ventricular systolic pressure 45 mmHg (systolic blood pressure 118 mmHg).
• Mild−moderate tricuspid valve regurgitation.
• Mildly dilated inferior vena cava with no inspiratory collapse
• Cirrhotic-appearing liver

Which of the following are indicated? (Click on the correct answer to proceed to the third of seven pages)

1. Diuresis
2. Tight control of her diabetes
3. Thoracic surgery consult
4. 1 and 3
5. All of the above

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