eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2021-04-26 9 8 402 406 10.12691/ajmcr-9-8-5 AJMCR2021985 article Samuel J Apple 1 Justin Lee 2 Meagan Freeze 3 Dahlia Rizk 4 Andrea Trimmingham 4 Samy I. McFarlane Smcfarlane@downstte.edu 4 College of Medicine, State University of New York-Downstate -Health Science University, Brooklyn, New York, United States- 11203 2Division of Cardiovascular Medicine, State University of New York-Downstate -Health Science University, Brooklyn, New York, United States- 11203 Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States- 11203 Division of Hospital Medicine, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine NY, NY 10003 Constrictive physiology is most commonly caused by pericardial effusions, constrictive pericarditis or large pleural effusions. Rarely, alternative etiologies may cause cardiac compression. In this report, we present a case of a 70-year-old woman with squamous cell carcinoma who was referred by her cardiologist for evaluation of pericardial and pleural effusions found on echocardiography. Initial clinical findings suggesting constrictive pericarditis, However, after further evaluation we determined that tense ascites was the underlying etiology of constrictive physiology in this patient. This diagnosis requires an integrative interpretation of multiple imaging modalities. Our case highlights the interdependent relationship between cardiac and hepatic pathology that needs to be considered on a case by case basis. Additionally, this case underscores the importance of maintaining a high degree of suspicion for extracardiac compression in the setting of cirrhosis, with prompt paracentesis to adequately prevent the life-threatening sequela of cardiac tamponade. http://pubs.sciepub.com/ajmcr/9/8/5/ajmcr-9-8-5.pdf ascites cirrhosis cardiac tamponade constrictive physiology