Matters of the heart: Pericarditis

Case presentation

A 13-year-old male presents to the emergency department (ED) with 2 weeks of chest pain. He describes the pain as sharp and constant, worsening over the past week. Two weeks ago, the patient had fever to 102 degrees Fahrenheit and cough. He then developed sharp frontal chest pain that he described as “stabbing.” The pain worsened when lying down. He was seen by his primary care provider and at that time had a chest radiograph and electrocardiogram (ECG) that were reported to be normal. He was diagnosed with a viral infection and prescribed symptomatic care. His fevers have resolved but the chest pain has worsened. He denies vomiting, abdominal pain, back pain, difficulty breathing, or trauma.

Physical examination reveals unremarkable vital signs other than mild tachycardia (heart rate of 110 beats per minute with a blood pressure of 110/70 mm Hg). He has slightly distant heart sounds and there appears to be a friction rub without a discernable murmur. His lungs are clear. An ECG is obtained, demonstrating low voltage throughout with no other acute abnormalities.

Imaging considerations

The choice of imaging modalities will depend on the clinical presentation, but when pericarditis is suspected, it will typically begin with plain chest radiography and may be followed by bedside ultrasound (US), echocardiogram, cardiac computed tomography (CT), or cardiac magnetic resonance imaging (MRI).