Sir.—The article by Strauss et al on constrictive pericarditis in children in the July issue of the Journal (128:822-826, 1975) emphasizes the importance of considering constrictive pericarditis in problems of hepatomegaly. I should like to reiterate that their first reported patient had been recognized to have cirrhosis six years before the diagnosis was made.
In a span of three years, we have seen three patients with constrictive pericarditis who were initially thought to have (1) unexplained cirrhosis for over two years, (2) severe infectious hepatitis with signs of liver cell failure and ascites, and (3) tuberculous peritonitis. No signs of heart failure were initially recognized in these patients. Prominence of veins around the face and eyes were clues in two of our patients. Neck veins were not obviously prominent. As in the reported cases, the cause in our three children with constrictive pericarditis has been completely unknown. I am writing