The Fortress Becomes a Prison: Calcified Constrictive Pericarditis.

PRESENTATION The pericardium, normally so useful in defending the heart from outside invaders, can perform more like a cage when its flexibility is compromised. We present the case of a 50-year-old man who was admitted to the nephrology unit when severe chronic hypotension led to poor hemodynamic tolerance during hemodialysis. He had a 24-year history of kidney disease of unknown etiology. At debut, he presented with pericardial effusion that required urgent initiation of hemodialysis. In 1993, he underwent a kidney transplant. Chronic graft dysfunction evolved, and in 2010, he started hemodialysis again. His medical history included chronic liver damage secondary to venous-occlusive disease induced by azathioprine and mesenteric thrombosis managed with oral anticoagulation. In 2011, he underwent subtotal parathyroidectomy for hyperparathyroidism.