Constrictive pericarditis secondary to underlying pericardial lymphoma

A woman in her 40s presented with fever, dry cough, shortness of breath and weight loss for the last 2 weeks. Examination revealed pallor and decreased breath sounds on the right side of the chest. On transthoracic echocardiography, there was moderate pericardial effusion with features of constrictive pericarditis. Cardiac magnetic resonance imaging confirmed thickened pericardium with septations and multiple pockets in the pericardial cavity filled with pericardial effusion along with late gadolinium enhancement. Despite all the supportive treatment, the patient's condition worsened and pericardiectomy was planned. During surgery, the pericardium was found to be densely adherent to the myocardium and highly vascular; therefore, the procedure was abandoned. However, multiple pericardial biopsies were taken, which later revealed high-grade B-cell lymphoma. Postoperatively, the patient developed worsening shock. Despite aggressive resuscitation, her condition continued to decline, and her family chose no further escalation of care. The patient eventually passed away.