Images of Memorable Cases: Case 46 Chest radiographs of a 55-year-old man with distended neck veins, distant heart sounds, hepatomegaly, ascites, and edema of the legs. 46. Calcified pericardium causing cardiac constriction The radiographs show striking pericardial calcification. Computed tomography (image below) further delineates the distribution and character of the calcification. The cause of the calcified pericardium in this case is unknown.