Cor calcium: heart trapped in a pericardial cage

A 47-year-old female patient was admitted to our hospital for the evaluation of shortness of breath. Her previous medical record was unremarkable. ECG revealed negative T waves in the inferior and precordial derivations (Fig. 1). Chest X-ray showed dense calcification around the heart, compatible with a calcified pericardium (Fig. 2a, b). Two-dimensional transthoracic echocardiogram revealed severe thickening and calcification of the pericardium, leading to the strangulation of the heart, but the extent of pericardial calcifications could not be estimated (Fig. 3a, b; Video 1).