Doppler echocardiographic signs to differentiate between chronic lung disease and right ventricular dysfunction in a child with calcified pericardium.

A 7 year-old girl was admitted with history of low-grade fever, weight loss and occasional cough for the last 6 months. Tuberculosis was suspected, for which antituberculous treatment was initiated. Chest X-ray demonstrated calcification of the pericardium with chest miliary shadowing. CT chest was done showing very fine sharply defined miliary nodularity throughout both lungs without mediastinal lymphadenopathy. The patient was referred to paediatric cardiology service to rule out constrictive pericarditis. Clinical cardiac examination as well as the electrocardiogram was normal. Echocardiography and Doppler were done showing normal cardiac anatomy and function apart from the detected pericardial calcification. Doppler tracing in the hepatic vein as well as in the superior vena cava could clearly exclude any negative effect on diastolic cardiac function, which could occur in the setup of pericardial calcification. Doppler, instead helped to identify the chronic pulmonary disease by showing increased inflow velocity throughout inspiration.