Constrictive pericarditis Investigation Initial evaluation Evaluate all patients with suspected pericardial disease using auscultation, ECG, TTE, CXR and routine blood tests, including markers of inflammation such as CRP and/or ESR, WBC count with differential, renal function, liver tests, and cardiac biomarkers. B Chest X-ray Obtain lateral and frontal CXRs in all patients with suspected constrictive pericarditis. B Transthoracic echocardiography Obtain TTE in all patients with suspected constrictive pericarditis. B Cardiac MRI/CT Obtain cardiac CT and/or cardiac MRI to assess calcifications (assessed on CT), pericardial thickness, degree and extension of pericardial involvement. B Cardiac MRI/CT Perform CT and/or cardiac MRI as second-line imaging techniques to assess for calcifications, pericardial thickness, and degree and extension of pericardial involvement. B Cardiac catheterization ESC Q Do non-invasive diagnostic methods confirm the diagnosis of constrictive pericarditis? No Perform cardiac catheterization when noninvasive diagnostic methods fail to confirm a definite diagnosis of constriction. B Yes iagnostic pericardiocentesis Q Does the patient have a pericardial effusion that is accessible by pericardiocentesis? Q Does the patient have suspected malignant pericardial disease? Yes to all Perform diagnostic pericardiocentesis with cytological analyses of pericardial fluid to confirm malignant pericardial disease. B No to any Continue management and follow-up as clinically appropriate.