Constrictive Pericarditis: There Is Nothing More Deceptive than an Obvious Fact

Introduction: we discuss the clinical case of a patient referred to our cardiology unit to evaluate the need for a pericardiectomy due to constrictive pericarditis. Imaging: the echocardiographic assessment confirmed all diagnostic criteria for constrictive pericarditis; however, we conducted a cardiac MRI before referring the patient to the cardiac surgeon. This imaging technique not only confirmed the constrictive pathophysiology but also indicated extensive pericardial inflammation, consistent with transient constriction. Clinical implications: this finding enabled us to initiate appropriate anti-inflammatory treatment, resulting in gradual clinical and instrumental improvements. Through this case, we aim to highlight the necessity of assessing the chronicity of the condition in all patients with constrictive pericarditis to determine the suitable treatment: surgical intervention for chronic cases and medical therapy for transient ones.