Diagnostic challenges in patients with constrictive pericarditis are considered in the article. Hemodynamic derangements include impaired ventricular filling, ventricular interdependence and reduced venous return. Clinical findings are typical for diastolic heart failure. Diagnosis of constrictive pericarditis is complicated by unclear or absent morphological signs of pericarditis while echocardiographic hemodynamic disturbances may be unobvious. Cardiac catheterization has been considered a gold standard for a long time. However, modern echocardiography is capable for thorough hemodynamic assessment. Mayo clinic echocardiographic criteria are characterized by high diagnostic accuracy and based on hemodynamic findings. Evolution of echocardiography has improved diagnosis and resulted in increase in the number of pericardiectomies. Other modalities including CT, MRI and invasive hemodynamic assessment are also analyzed in the manuscript.