Shelled heart: tuberculous constrictive pericarditis

A 55-year-old man presented with progressive distension of the abdomen, pedal oedema, effort dyspnoea and excessive fatigue. Physical examination showed facial puffiness, distended neck veins with prominent Y descent in jugular venous pressure, ascites, systolic retraction of the chest wall and a loud pericardial knock. Echocardiography showed greatly thickened pericardium (figure 1A) …