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case_images: Electrocardiogram, echocardiography, and chest X-ray at diagnosis, showing widespread ST-elevation (arrows) (A) and haemodynamically relevant pericardial effusion (arrows) (B)-D).
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case_images: Chest X-ray revealed cardiomegaly (Figure 1).
case_images: Echocardiography showing initial mitral flow respiratory variations (A) and normal mitral annular velocity with 'annulus reversus' (B and C). Cardiac magnetic resonance imaging (D) and cardiac catheterization (E) depicting increased pericardial thickness (orange arrows) and left ventricular and right ventricular diastolic pressure equalisation (arrows).
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case_images: Supplementary material online, Videos S2 and S3) and cardiac catheterization confirmed some elements in favour of a constrictive pattern: pericardial thickening and similar tele-diastolic pressure profile in right and left ventricles (Figure 2). Specifically, during cardiac catheterization, it was observed that both ventricles overfilled and then stopped filling abruptly, resulting in the equalization of diastolic pressures in all chambers [mean diastolic left ventricle pressure 9 mmHg (NV <10 mmHg), mean diastolic right ventricle pressure 8 mmHg (NV 8-15 mmHg), mean right atrium pressure 8 mmHg (NV 0-6 mmHg), and pulmonary capillary wedge pressure 11 mmHg (NV 6-12 mmHg)].
case_images: Echocardiography (A-D) showing the absence of constrictive pattern after IL-1R antagonist treatment.
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case_images: This therapy offered a better control of the symptoms and biochemical inflammation, with complete remission of echocardiographic findings of constriction (Figure 3).