Constrictive pericarditis may exceptionally present as pleural effusion of unknown origin and this form of presentation may cause diagnostic problems. We report a case of subacute constrictive pericarditis in which there were recurrent pleural effusion with no other signs of the disease and the initial echocardiographic study was nondiagnostic. For this reason the patient was initially considered to have primary pulmonary or pleural disease. On the basis of the subsequent development of signs of systemic congestion and the results of computed tomography, Doppler echocardiography and cardiac catheterization, which were consistent with constriction, it was concluded that the patient had constrictive pericarditis. A complete resolution of pleural effusion and signs of systemic congestion was observed following pericardiectomy.
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