When a woman presented to ED with palpitations that were only relieved by passing gas or having a bowel movement, the cause undoubtedly made doctors’ hearts drop into their stomachs.

But it was the patient’s colon dropping in on her heart that was the culprit in this case.

The 54-year-old had a medical history significant for constrictive pericarditis, which had been treated with pericardial drainage 15 years earlier.

Owing to the atypical presentation, a thoracic–abdominal–pelvic CT with IV contrast material was carried out and showed the transverse colon poking through the pericardial cavity, as well as pericardial calcification (red arrow).