Atypical Presentation of Constrictive Pericarditis With Constrictive Physiology on Cardiac MRI

Constrictive pericarditis (CP) is a disease primarily affecting the pericardial sac surrounding heart. The constrictive physiology placed on heart chambers can lead to clinical presentations mimicking failure and possibly primary liver disease. diagnosis often be missed attributed other etiologies until patient undergoes extensive workup rule out each potential etiology. Diagnosis delayed, leading suboptimal outcomes mortality rates. Here, we present case of CP initially presenting with bilateral lower extremity scrotal edema, alcoholic cirrhosis given patient’s history alcohol abuse. Subsequent abdominal imaging found no evidence cirrhosis, coupled grossly normal echocardiogram that led eventually based cardiac MRI. later underwent pericardiectomy made full recovery. This highlights ambiguous presentation CP, utility MRI in diagnosis, need for specific criteria help guide future diagnoses as modalities continue evolve.