Pericardial constriction with calcified cystic mass compressing the right ventricle and right coronary artery

Constrictive pericarditis is characterized by fibrosis and calcification of the pericardium that progressively impair the diastolic filling of the heart, causing heart failure. Uncommonly, pericardial constriction may be localized leading to a focal cystic mass formation that may compress nearby cardiac structures. We describe a unique case of a patient presenting with right heart failure due to idiopathic calcific constrictive pericarditis that was associated with a large pericardial cystic mass compressing the right ventricular free wall. This led to reduced cardiac output and possibly severe focal stenosis of the proximal right coronary artery that was resolved after pericardiectomy, the only definitive treatment for chronic progressive constrictive pericarditis. <Learning objective: Constrictive calcified pericarditis with localized cystic mass formation may lead to focal compression of nearby cardiac structures, causing right heart failure with cirrhosis-like symptoms and reduced cardiac output. Uncommonly, epicardial coronary obstruction is encountered, which may be reversible after pericardiectomy. Multi-modality imaging is often necessary to establish diagnosis, especially when unexplained heart failure exists.>.