Contrast enhanced CT chest shows thickened pericardium (6-7 mm in thickness) with foci of pericardial calcifications adjacent to both ventricles and inferior wall of right ventricle. Both ventricles have tubular configuration with moderate biatrial dilatation. These features are suggestive of calcific constrictive pericarditis.
Moderate right pleural effusion and mild to moderate left pleural empyema are also seen (split pleura sign on left).
Peripheral fibrotic changes with traction bronchiectasis is noted in left lower lobe basal segments, adjacent to the empyema. Few benign appearing soft tissue density nodules are noted in the periphery of the left upper lobe. Otherwise, both lungs appear normal.
Few prominent mediastinal lymph nodes are noted with faint nodal calcifications.
Tricuspid regurgitation (reflux of contrast into IVC and hepatic veins) is also seen with secondary cardiac cirrhotic changes in the liver.
Overall features are in favour of tubercular aetiology for thickened, calcified pericardium.