Acute pericarditis

Case contributed by Dr Euan Zhang

Presentation

Presented to the ED with acute pleuritic chest pain. A CT PA was requested to rule out PE.

Patient Data

Age: 40
Gender: Male
CT

CT Chest

The pericardium is thickened and enhancing, with adjacent epicardial and pericardial stranding.  These findings are new compared to the visualized thorax from a CT of the abdomen/pelvis two months prior.

Two incidental hemangiomata are visualized in the liver.

Photo

ECG

Diffuse ST elevation with upward concavity and PR depression, consistent with pericarditis.

Case Discussion

The findings on the CT PA are consistent with acute pericarditis.

The patient presented with pleuritic chest pain, for which the ED needed to exclude pulmonary embolism.  The CT PA shows no evidence of PE, but shows thickening and enhancement of the pericardium, which did not exist two months prior.  The findings are subtle.  The pericardium measures approximately 2 mm on the current exam, which is equivocal.  However, when compared to the previous exam, the interval development of relative thickening, enhancement, and adjacent stranding become apparent.  The visualized lower thorax from the prior CT is extremely helpful.  

The ECG findings are also classic for pericarditis.

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Case information

rID: 51129
Case created: 5th Feb 2017
Last edited: 9th May 2017
Systems: Chest, Cardiac
Inclusion in quiz mode: Included

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