Purpose: Constrictive pericarditis post lung transplant is a rare diagnosis with an incidence of 0.4% [1]. We report a series of 5 consecutive patients from our centre, highlighting prompt clinical suspicion and diagnosis leading to successful pericardiectomy. Methodology: A database review selected all patients who underwent pericardiectomy for constrictive pericarditis post lung transplantation between January 2018 and June 2024. Results: 5 patients were diagnosed with constrictive pericarditis with a median time interval of 17 months (10-34 m) after lung transplantation. All were male with a median age of 55 years (31-72 y). Two patients had bronchiectasis and one each had IPF, Cystic Fibrosis and COPD. All patients presented with worsening dyspnoea and on interrogation, symptoms of right heart failure. Echocardiogram, MRI and right heart catheter study confirmed the findings of constriction for all patients except 1. Total pericardiectomy was performed via median sternotomy in all patients. 3 patients required cardiopulmonary bypass. 2 patients had early rejection with deteriorating lung function which were medically managed. 1 patient underwent sternal plating and bone grafting for malunion at the time of pericardiectomy. Median ICU stay post transplantation was 2 days (2-4 d), and median time for which drains were kept were 8 days (5-13 d). 2 patients were diagnosed with COVID in this period. Histopathology of the pericardium revealed fibrous pericarditis in all the patients. All patients had an uneventful recovery. There was no mortality. Conclusion: Constrictive pericarditis post lung transplant is confounded by its clinical and radiological presentation. Prompt diagnosis by conventional means leads to early pericardiectomy and hence should be standard of care. Reference: 1.Armstrong B.L et al. Constrictive pericarditis after lung transplantation. Transplantation 2020;104: 1081-1084