A 63-year-old woman with a pericardial effusion, bilateral pleural effusions, and ascites: is the whole greater than the sum of its parts?

A 63-year-old female presented with dyspnea, leg edema, and abdominal distention. Exam revealed blood pressure of 104/58, pulse 108/min, jugular venous pressure of 8 cm, no pulsus paradoxus, a pericardial rub, muffled heart sounds, decreased basilar breath sounds, ascites, and ankle edema. Electrocardiogram showed low voltage. Imaging revealed thickened pericardium and a pericardial effusion. Hemodynamic tracings postpericardiocentesis revealed elevated right-sided pressures. The patient was diagnosed with effusive constrictive pericarditis. The case and review of this condition are described. Patients with a pericardial effusion and symptoms unresponsive to pericardiocentesis or with pericardial thickening should undergo evaluation for effusive-constrictive pericarditis.