A 64-year-old man presented with progressive swelling of the scrotum for four days, accompanied by gradually increasing dyspnea on exertion and cough severity. The chest radiograph disclosed a normal heart size but severe, dense calcifications in the pericardium. Echocardiography demonstrated thickness and calcification of the pericardium, normal left ventricular systolic but impaired diastolic function, dilatation of both atria and respiratory variation in both the mitral and tricuspid forward flow. The typical ultrasound findings enabled us to differentiate constrictive pericarditis from restrictive cardiomyopathy. The patient refused a pericardiectomy, so medical treatment was instituted.