Acute pericarditis

Case contributed by Dr Euan Zhang


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

Patient Data

Age: 40 years
Gender: Male

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.

Previous study two months prior from CT of the abdomen


CT of the abdomen performed two months prior. 



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

Case Discussion

The findings on the CT pulmonary angiography (CTPA) 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 pulmonary embolism 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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