• General
  • Incidence
    • About 4% following transmural infarction
    • Probably higher in open heart surgery
• Believed to have immunologic cause
  • Possibly a latent viral infection may be involved in cause
• Clinical
  • Symptoms typically appear 2-3 weeks following infarct/surgery–sometimes years
  • May last for weeks or months
    • Different from more common post myocardial infarction pericarditis
      • That entity occurs in 17 to 25 percent of cases of acute myocardial infarction
      • Occurs between days 2 and 4 after the infarction
  • Pleuritic chest pain (91%)
  • Fever
  • Pericardial and pleural effusion
    • Pericardial friction rub
    • Effusions can be bloody and cause tamponade
  • Also rales
  • SOB
  • Leukocytosis
• Imaging Findings
  • Pleural effusions (83%)
  • Parenchymal opacities (74%)
  • Enlarged cardiac silhouette from pericardial effusion (49%)

Three sequential images of the chest show a pre-op chest in which the left lung base is clear (green arrow);
on the third day post-op coronary artery jump bypass surgery, there is subsegmental atelectasis
at the left base (yellow arrow);
Four weeks later, there is a left pleural effusion and subsegmental atelectasis visible (red arrow)
Click here for the same image without the arrows

• Treatment
  • High dose aspirin
  • Steroids