Squeezing the Heart: Right Ventricular Aneurysmal Deformation and Extreme Thrombotic Risk in Constrictive Pericarditis due to Cardiac Sarcoidosis

Constrictive pericarditis in the setting of cardiac sarcoidosis is an uncommon but severe manifestation of granulomatous heart disease, capable of producing irreversible structural deformation and life-threatening haemodynamic compromise. Progressive calcific pericardial encasement can result in focal aneurysm-like deformation of the right ventricular outflow tract-a consequence of chronic external constraint rather than intrinsic myocardial pathology. This case illustrates the complementary role of multimodal cardiac imaging in characterizing this phenotype and documents the catastrophic thromboembolic vulnerability inherent to its clinical context. Despite periprocedural interruption of oral anticoagulation limited to a single withheld dose before cavotricuspid isthmus ablation for atrial flutter, the patient sustained simultaneous acute left middle cerebral artery infarction and bilateral pulmonary embolism within 48 h, underscoring the imperative for risk-stratified, individualized anticoagulation management in this population.