Investigations

The American College of Cardiology and the European Society of Cardiology guidelines recommend echocardiography for diagnosing constrictive pericarditis and other pericardial diseases. Two-dimensional echocardiography may show increased pericardial thickness, with or without calcification. This technique may also reveal dilation of the inferior vena cava without inspiratory collapse. Other investigations include:

• ECG - although no specific electrocardiographic findings of constrictive pericarditis occur, this test may reveal nonspecific ST-segment changes and low voltage
• chest X-ray - may show a small cardiac shadow and there may be peripheral calcification
• cardiac MRI scan - this can provide confirmatory information or help rule out the diagnosis. MRI features suggestive of constrictive pericarditis include pericardial thickening, pericardial calcification, myopericardial tethering, diastolic restraint, and dilation of the inferior vena cava. (2)

Reference

1. Khraishah H, Kwun A, Dearani JA, Alfaddagh A. Constrictive Pericarditis: A Comprehensive Overview. Heart Views. 2025 Jul-Sep;26(3):188-197
2. Wang TKM et al. Cardiac Magnetic Resonance Imaging Techniques and Applications for Pericardial Diseases. Circ Cardiovasc Imaging. 2022 Jul;15(7):e014283