• Marked enhancing pericardial thickening with calcification, suggestive of pericarditis
• Biatrial enlargement, conical deformity of the ventricles and diastolic septal flattening are noted.  Prominence of the IVC, SVC and presence of ascites. Imaging findings are consistent with constrictive physiology
• Diffuse hypokinesia involving the ventricles
• No focal late gadolinium enhancement to suggest myocardial infiltration/fibrosis

• Constrictive pericarditis

Pericarditis is inflammation of the pericardium that can be idiopathic (30%) or caused by various abnormalities, such as infections (viral, bacterial, fungal, tuberculosis);connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis); radiation; uremia; myocardial infarction (early epistenocardica or Dressler Syndrome)

Acute pericarditis:
Acute pericarditis is characterized pathologically by the presence of vascularized granulation tissue, fibrin, and fluid. Clinically, it presents with pleuritic-type retrosternal chest pain. MRI shows pericardial thickening with enhancement – may be focal or diffuse and effusion.

Chronic inflammatory pericarditis:
Chronic fibrosing pericarditis is characterized by the presence of calcification and noncompliant pericardium. MRI shows thick pericardium, which has low signal on all the sequences because of fibrosis or calcification. Pericardial fluid is either minimal or absent. Contrast enhancement is variable seen in cases with residual inflammation. Features of pericardial constriction may be present.

Chronic fibrosing pericarditis:
Chronic inflammatory pericarditis is characterized by irregularly thickened pericardium with mild effusion. Variable contrast enhancement is seen.

Pericardial constriction:
Pericardial constriction is caused by thickened, fibrotic or calcified, nonelastic pericardium that impairs left ventricle diastolic filling and results in elevated systemic venous pressures and low cardiac output. Clinical features are caused by low cardiac output (fatigue, hypotension, and tachycardia), elevated systemic venous pressure (jugular venous distention, hepatomegaly, ascites, and edema), and pulmonary venous congestion (dyspnea, orthopnea, and cough). Pericardial thickening (> 4 mm) is an indicator of constriction in patients with the appropriate symptoms and signs of right heart failure.

Long-standing constriction results in conical deformity of the ventricles. Other findings of constriction due to elevated cardiac filling pressures are seen: biatrial enlargement, narrow atrioventricular groove; dilated SVC & IVC, pleural effusion and ascites. Tethering and restricted ventricular expansion adjacent to thickened areas is seen, finding documented using tagging. Tag lines are typically displaced during the cardiac cycle in healthy persons because of the free motion of the pericardium, whereas in patients with pericardial constriction, the tag lines are stretched and fail to break because of restricted motion between the pericardial layers.Diastolic interventricular septal flattening is a finding that has a sensitivity of 62–81% and specificity of 93–100% for constriction in the diagnosis of constriction. Respiratory variation in this septal movement is a pathognomonic feature of pericardial constriction.

• MRI can differentiate constriction from the clinically similar restrictive cardiomyopathy
• In addition, MRI can exclude other causes of right heart failure, such as pulmonary hypertension, shunts, right ventricle dysplasias, and right ventricle infarction
• Can determine if thickened, inflamed, or nonthickened pericardium is causing constriction; and evaluate whether the patient will benefit from pericardial stripping