Endomyocardiopericardial fibrosis (EMPF). A shortaxis view from a patient with advanced EMF and intractable heart failure. The endocardium looks dense and bright with the myocardium clearly seen underneath it. The striking finding is the appearance of densely fibrosed and calcified pericardium with effusion forming an endomyocardiopericarial fibrosis. Note the presence of pericardial effusion and the posterior papillary muscle being engulfed by the thickened endocardium.