70 year old male with past history of pulmonary Koch's came with increasing breathlessness and chest pain. CT chest showed calcified, thickened pericardium with tubular morphology of both ventricles and biatrial dilatation - consistent with calcific constrictive pericarditis. 

Secondary changes of constrictive pericarditis were also seen in the form of moderate right pleural effusion and tricuspid regurgitation. 

Left pleural empyema and few calcified mediastinal lymph nodes suggest to the possible tubercular etiology for pericarditis.

Cardiac cirrhosis of liver was also seen.

It is important to differentiate constrictive and restrictive cardiomyopathy. CT and MRI are complementary to each other in coming to the conclusion. CT helps in depicting pericardial calcifications.