Introduction <p>Effusive constrictive pericarditis (ECP) is a syndrome of combined pericardial effusive and constrictive physiology. Historically, it was a rare diagnosis which required invasive cardiac catheterisation confirmation post drainage of the pericardial effusion. However, the emergence of reliable echocardiographic features of constrictive disease has improved diagnostic yield.</p> Case <p>We present a case of a 34-year-old patient with a pericardial effusion secondary to tuberculous pericarditis which demonstrated constrictive features on echocardiogram pre-pericardiocentesis and on invasive cardiac catheterisation measurements post pericardiocentesis – consistent with ECP. Ultimately this patient required a pericardiectomy for refractory symptoms of right heart failure despite pericardiocentesis.</p> Discussion <p>We utilise this case to highlight the rare clinical entity of ECP but also to demonstrate the complex haemodynamics which govern pericardial effusions, constrictive pericarditis and ECP.</p>