The patient underwent further workup. Chest x-ray (CXR) showed no focal pulmonary consolidation, cardiac enlargement or pericardial calcification. Inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and high-sensitive C-reactive protein (hs-CRP) were elevated. High-sensitivity troponin and brain natriuretic peptide (BNP) levels were within normal limits. A 12-lead electrocardiogram (ECG) demonstrated normal sinus rhythm. Echocardiogram displayed diastolic septal bounce and the presence of mild constrictive physiology with annular reversal (Figure 1) .

Cardiac magnetic resonance imaging (CMR) identified mild pectus deformity (Haller Index: 3.6) and mild late gadolinium enhancement (LGE) in the absence of pericardial edema (Figures 2,3,4) .