Postpericardiotomy Syndrome

Dressler’s Syndrome/Postmyocardial Infarction Syndrome/
Postcardiac Injury Syndrome

 

General Considerations

• Autoimmune and febrile illness that can follow coronary artery bypass surgery
• May also be seen following myocardial infarction (Dressler’s syndrome)
• Reported to occur in 10-40% of cases
• Combination of pericarditis, pleuritis and pneumonitis
• Believed to have immunologic cause
• Possibly a latent viral infection may be involved in cause

Clinical Findings

• Symptoms typically appear 2-3 weeks following infarct/surgery–sometimes years
• May last for weeks or months
• Pleuritic chest pain (91%)
• Fever
• Pericardial and pleural effusion
• Pericardial friction rub
• Effusions can be bloody and cause tamponade
• Also rales
• Shortness of breath
• Leukocytosis

Imaging Findings

• Diagnosis can usually be made from a combination of the clinical picture and chest radiographs (95% abnormal)
• Cardiac silhouette enlargement from pericardial effusion and mild to moderate-sized left (usually) pleural effusion
• Pleural effusion may be bilateral
• Pleural effusions (83%)
• Parenchymal opacities (74%)
• Enlarged cardiac silhouette from pericardial effusion (49%)

Differential Diagnosis

• Different from more common post myocardial infarction reactive changes
• Occurs between days 2 and 4 after the infarction
• Congestive heart failure
• Pneumonia
• Reaction to medication

Treatment

• High dose aspirin
• Steroids