Pericarditis, an inflammation of the pericardial sac, can be caused by infectious, autoimmune, metabolic, traumatic, iatrogenic, and drug-related entities. Not infrequently, the inflammatory process also involves the contiguous myocardium, with associated elevation in cardiac enzymes. In some instances, pericarditis is associated with constrictive pericarditis, the diagnosis of which can be challenging. Cardiac ultrasound is critical to the diagnosis of constrictive pericarditis. The finding of annulus reversus––the medial early diastolic tissue Doppler velocity exceeding the lateral velocity—can be of particular diagnostic value. It is hypothesized that this finding is due to a reduction in the longitudinal motion of the lateral annulus by the constrictive diathesis.4 In the case we are presenting herein, we demonstrate an example of annulus reversus whose origin may be related more to myocardial scar than to the inflammatory changes in the pericardium.