Reversible Advanced Liver Fibrosis in Pediatric Constrictive Pericarditis.

BACKGROUND: Chronic constrictive pericarditis is a rare cause of heart failure in children and may present with nonspecific symptoms. Chronic venous congestion can result in liver injury mimicking cirrhosis. CASE SUMMARY: An 8-year-old boy presented with exercise intolerance, dyspnea, and longstanding gastrointestinal symptoms leading to a diagnostic delay of nearly 5 years. Evaluation revealed hepatomegaly and advanced liver fibrosis (METAVIR F4) on elastography, despite preserved liver function. Multimodality cardiac imaging demonstrated features consistent with constrictive pericarditis. The patient underwent successful pericardiectomy. At 3-month follow-up, liver stiffness regressed to METAVIR F1, indicating reversal of congestion-related fibrosis. DISCUSSION: Diagnosis of pediatric constrictive pericarditis remains challenging. This case demonstrates that advanced fibrosis due to venous congestion may be reversible after correction of the underlying hemodynamic abnormality. TAKE-HOME MESSAGES: Constrictive pericarditis should be considered in children with systemic venous congestion. Timely surgical treatment may lead to reversal of liver fibrosis.