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Cardiovascular Images

Acute Isolated Viral Pericarditis With Rapid Progression to Constrictive Pericardial Disease

Philipp Stawowy, MD; Cosima Jahnke, MD; Engin Osmanoglou, MD; Roland Hetzer, MD; Eckart Fleck, MD and Ingo Paetsch, MD

From the Department of Internal Medicine/Cardiology (P.S., C.J., E.O., E.F., I.P.), and Department of Cardiothoracic Surgery (R.H.), German Heart Institute, Berlin, Germany.

Correspondence to Ingo Paetsch, MD, Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail paetsch@dhzb.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A previously healthy 42-year-old man presented with fatigue and progressive dyspnea 6 weeks after an episode of massive diarrhea that required supportive intravenous therapy.

A chest x-ray showed bilateral pleural effusion and echocardiography demonstrated extensive pericardial effusion, whereas global systolic right and left ventricular function appeared preserved (Figure 1A).

View larger version (30K):   Figure 1. Echocardiographic still frames of a four-chamber view at endsystole. (A) During initial presentation, extensive pericardial effusion (white arrow) and a "swinging heart" pattern were seen. (B) Six months later, paradoxical motion of the interventricular septum and an echo-intense pericardium were found (white arrowheads).

 
The patient was referred to cardiac magnetic resonance imaging for suspected inflammatory involvement of the myocardium; cardiac magnetic resonance imaging demonstrated acute inflammation confined to the visceral and parietal pericardial layers (Figure 2A through 2D). Extensive laboratory testing for tuberculosis, autoimmune, and systemic diseases was inconspicuous except for an elevated coxsackie A virus IgM serum titer (1:640). Immunohistologic examinations of right-sided endomyocardial biopsy samples revealed no inflammatory reaction of the myocardium. After successful needle pericardiocentesis and medical treatment with ibuprofen, the patient recovered rapidly and was discharged home in a symptom-free state.

View larger version (90K):   Figure 2. Cardiac MR imaging in short-axis orientation. Images labeled (A–D) were acquired at first presentation; (E–H) during repeat cardiac MR imaging six months later. (A, E) cine imaging (SSFP sequence) at endsystole. (B, F) T1-weighted blackblood imaging with fat saturation prepulse (SPIR). (C, G) T2-weighted blackblood imaging. (D, H) delayed enhancement imaging (intravenous dosage of Gad-DTPA 0.2 mmol/kg, inversion . . . [Full Text of this Article]