Diagnostic studies-pericarditis and pericardial effusion

• Need ≥2 of the following: chest pain (as noted above), friction rub, ECG findings, effusion
• typical electrocardiogram in a patient with acute pericarditis
• CXR: if lg effusion (>250 mL) → ↑ cardiac silhouette w/ “water-bottle” heart & epicardial halo
• Echocardiogram: presence, size, & location of effusion; presence of tamponade physiology; pericarditis itself w/o spec. abnl (∴ echo can be nl), although can see pericardial stranding (fibrin or tumor); can also detect LV/RV dysfxn (myocarditis?)
• CT: effusion (often larger by CT than by echo) ± calcif.; pericard. enhancement w/ contrast
• MRI: may reveal pericardial thickening/inflammation, as well as myocardial involvement
• ⊕ cTn in ~30%, indicative of concomitant myocarditis (JACC 2003;42:2144). Inflammatory biomarkers (ESR, CRP) elevated in 80% of presentations; CRP predicts recurrence.