Purulent pericarditis

Case contributed by Derek Smith

Presentation

Chest pain and breathlessness. Increased WCC and CRP.

Patient Data

Age: 30 years
Gender: Male
x-ray

AP projection.

Left lower zone hazy opacification / consolidation with small left pleural effusion.

x-ray

Clinically worsening over 3 days (CRP now >400):

PA projection.

Progressive left lower zone consolidation, with increased bilateral pleural effusions, larger on the left.

Increased cardiothoracic ratio, with globe like appearance on both previous AP and this PA CXR.

ct

Moderate pericardial effusion (depth between 10-20 mm) with enhancement of the parietal and visceral layers indicating infection / inflammation.

Bilateral pleural effusions, with no pleural enhancement or definite evidence of empyema formation.

RML, RLL and LUL atelectasis, with partial collapse of LLL. No pulmonary nodules or septic emboli.

Small reactive upper mediastinal nodes. No features of pulmonary tuberculosis, with no risk factors in clinical history.

No large vessel PE.

Normal included skeleton and upper abdominal structures.

Case Discussion

This young adult presented with non-specific chest pain and breathlessness with an inflammatory picture of elevated WCC and CRP.

Despite antibiotic management there was clinical deterioration with worsening CXR appearances, and CT confirmed an enhancing pericarditis.

Enhancement of the pericardial layers is indicative of inflammation (c.f. sterile pericarditis), typically with bacterial infection.

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