Pericarditis with pericardial effusion


This case illustrates pericardial effusion with pericarditis in a patient, who underwent percutaneous coronary intervention (PCI) because of a non-ST elevation myocardial infarction (NSTEMI).

Chest x-ray shows:

  • a pericardial fat stripe or oreo cookie sign
  • small bilateral pleural effusions

Cardiac MRI findings are:

  • a moderate, circular pericardial effusion
  • pericardial thickening, pericardial edema and enhancement

The patient was conservatively treated and had a decrease of the pericardial effusion and improvement of symptoms as well as systolic dysfunction. In absence of any other specific cause and high-risk features the etiology was felt to be most likely idiopathic vs post-myocardial infarction pericarditis. Eventually, the patient was sent home with the recommendation of restriction in physical activity and echocardiographic follow-up.

Perimyocarditis is a typical differential of pericarditis especially in the setting of elevated troponins 4. However, no main diagnostic findings for myocardial inflammation as recommended in line with the original or updated Lake Louise criteria 5,6 could be demonstrated and the elevation in troponins can by all means explained with the non-ST-elevation myocardial infarction (NSTEMI).

Another differential diagnosis to think about in a patient with pericardial effusion in a non-ST-elevation myocardial infarction would be Stanford type A aortic dissection 7.

    Create a new playlist