Pericarditis with pericardial effusion
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).