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BACKGROUND: Constrictive pericarditis is a rare cause of dyspnea. This disease shares many signs and symptoms with other causes of cardiac failure as well as gastrointestinal and renal diseases, making it difficult to diagnose. CASE REPORT: We present a case of a 73-year-old woman who presented to our Emergency Department (ED) in respiratory failure after a recent history of worsening dyspnea. Constrictive pericarditis was strongly suspected on bedside ultrasonography. Computed tomography scan showed extensive pericardial calcifications and large pleural effusions, supporting the diagnoses. The patient was admitted for treatment and evaluation of constrictive pericarditis, but died of complications during cardiac catheterization. CONCLUSIONS: The etiology and physiology of constrictive pericarditis are reviewed and an ultrasound-centered approach to undifferentiated dyspnea in the ED is discussed