Effusive constrictive pericarditis (ECP) is a relatively infrequent pericardial condition. The diagnosis is typically made when symptoms and right heart pressure elevation persist despite drainage of pericardial effusion. Visceral and parietal pericardial stripping is an extensive procedure with significant morbidity and mortality but is widely considered the only effective treatment. Recent studies suggest that up to 10% of constriction may be reversible, and a newer series has reported spontaneous complete resolution of symptoms in a subset of ECP patients. In this review, the authors describe 2 patients with ECP who were managed successfully with steroids and colchicine, respectively, thus obviating the need for surgery. The authors also review the current understanding of this reversible pericardial pathology and explore the possible role for colchicine in treating this condition.