A 37-year-old man with chest pain, ECG changes, and elevated cardiac enzymes
ACUTE PERICARDITIS: WHAT IS THE CAUSE?
2. Which is the most common cause of acute pericarditis?
- Idiopathic
- Neoplasm
- Autoimmune
- Tuberculosis
Most (approximately 80%) of cases of acute pericarditis are idiopathic.6,7 In a study in 100 patients with acute pericarditis,6 a specific cause was identified in only 22. The most common identified cause was neoplasm, which was present in seven patients: four with lung cancer and one each with breast carcinoma, cystic duct adenocarcinoma, and cardiac angiosarcoma.
CASE CONTINUES: PERICARDIAL EFFUSION
The patient is admitted to the hospital for additional workup. His fever, myalgia, and chest pain persist, though the pain is less intense than before.
A chest roentgenogram and transthoracic echocardiogram are ordered and blood cultures are drawn.
The roentgenogram shows marked cardiomegaly, bilateral small pleural effusions, and minimal atelectatic changes in the lungs.
Echocardiography reveals a normal ejection fraction (60%) and a moderate-sized pericardial effusion without evidence of tamponade.
3. Which is the most common cause of pericardial effusion?
- Idiopathic
- Infection
- Malignancy
- Collagen vascular disease
Pericardial effusion is relatively common after acute pericarditis but also has many other possible causes. In a study of 204 patients with pericardial effusion,8 48% of cases were labeled as idiopathic. Of the remaining 52%, the most common specific diagnoses were infection (16%) and cancer (15%). Collagen vascular disease accounted for 8% of the cases and included systemic lupus erythematosus, rheumatoid arthritis, and scleroderma.
Although small pericardial effusions are common in pericarditis, larger pericardial effusions or failure to respond to therapy necessitates additional workup.2
In our patient, an extensive workup is initiated to look for bacterial, viral, fungal, and autoimmune causes of pericardial effusion, but the results of the workup are negative.
