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A 46-year-old female presented to her general practitioner with abdominal pain, lethargy, dyspnea and pedal edema. Computed tomography (CT) revealed features of heart and liver failure with pleural fluid and ascites and the liver having a cirrhotic appearance. A gastroenterologist confirmed the diagnosis of cirrhosis, but the etiology was unknown. Pericardial calcifications and elevated jugular venous pressure on examination gave rise to a suspicion of constrictive pericarditis as the cause of the liver cirrhosis. Cardiac catheterization confirmed pericardial constriction, and the patient underwent a total pericardiectomy.

It is easy to miss a diagnosis of constrictive pericarditis because it must be specifically sought after in the echocardiogram, and pericardial calcifications are only present in a minority of cases.