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.