Purpose: Background: Ascites is a common finding in patients with cirrhosis. The non-hepatic causes of ascites include venous or lymphatic obstruction, nephrotic syndrome, and congestive heart failure. Constrictive pericarditis (CP) is characterized by pericardial inflammation and subsequent scarring and contracture of the pericardium. The clinical manifestation of CP is usually congestive heart failure (CHF) which results in a “nutmeg liver” due to chronic congestive changes in the liver. Histologic findings in the liver include sinusoidal dilatation, fibrosis around spared portal regions and hemorrhagic necrosis in zone 3 of the hepatic lobule. Recently, the prevalence of CP has declined significantly due to increased focus on preventive medicine and improved diagnostic capability. Thus, CP with congestive hepatopathy (CH) has not been reported. We report a case of CH with ascites caused by CP. Case Report: A 78 year-old male with history of hypertension, diabetes, and dyslipidemia presented with gradual increase in abdominal girth over 5–8 months; this was attributed to ascites. The patient denied dyspnea at rest or on exertion and orthopnea. He denied alcohol or drug use, and history of previous liver disease or radiation exposure. Patient's mild abdominal pain was relieved by a paracentesis; 5 liters of transudative fluid were removed. The serum ascites albumin gradient was 1.0. An abdominal CT scan showed cirrhosis and extensive calcification in the inferior pericardium. The latter finding was confirmed on a CT scan of the chest. Tuberculin skin test was negative. Platelet count was 270,000/μL, sodium 137 mEq/L, creatinine 1.5 mg/dL, prothrombin time 22 seconds, aspartate aminotransferase 19 U/L, alanine aminotransferase 24 U/L, alkaline phosphatase 89 U/L, bilirubin 6.4 mg/dL. Hepatic sinusoidal pressure was 16 mmHg; liver histology was consistent with CH. Transthoracic Echocardiogram revealed biatrial enlargement and normal left ventricular ejection fraction. Right and left heart catheterizations indicated relative equalization of pressures in the cardiac chambers, restrictive physiology and a pulmonary artery wedge pressure of 62 mmHg. The patient underwent an anterior pericardiectomy; however, ascites reaccumulated requiring numerous paracenteses. Discussion: This case illustrates that CP needs to be considered as an etiology of CH, cirrhosis and ascites. In our patient, pericardiectomy was unsuccessful in completely resolving ascites, highlighting the importance of early pericardiectomy and appropriate CHF management to prevent cirrhosis. Although CHF has been associated with CH, this is the first case of CP and CH. Methods: NA Results: NA Conclusion: NA