Summary

We present a case referred for endoscopy because of symptoms of dyspepsia and abnormal liver function tests. These more obvious symptoms masked an underlying history of shortness of breath on exertion and mild bipedal oedema. Physical examination revealed a raised jugular venous pulse with pulsus parodoxus, hepatomegaly, mild ascites and slight bipedal oedema. Investigations confirmed the presence of idiopathic calcific constrictive pericarditis. An early surgical pericardiectomy led to resolution of symptoms and signs, and a normalisation of liver biochemistry.