**4. Radiographic imaging**

Radiographic imaging is considered a useful method to identify metallic objects within the reticulum and adjacent structures, as well as highlighting findings such as cardiomegaly and abnormal cardiac shape [21]. One caveat of using radiography in late-stage pericarditis is that often, fibrinous deposits, adhesions, pleural effusion and pneumopericardium can be so severe that there is a profound loss in thoracic detail making it difficult to identify offending object(s) [6, 10, 22]. A lack of a foreign object seen on thoracic radiographs does not rule out TP, and as a result, the sensitivity of radiography as a diagnostic technique is limited [11, 22]. Additionally, in cases of extensive fluid accumulation or concurrent pleural effusion with TP, radiographic changes will be indistinguishable from other cardiac pathologies such as pleuritis [10].
