Smoldering recurrent pericarditis presenting as a loculated pericardial effusion mimicking pericardial cyst
Al-Darzi W, and Gindi R. Smoldering recurrent pericarditis presenting as a loculated pericardial effusion mimicking pericardial cyst. Journal of the American College of Cardiology 2020; 75(11):2648.
J Am Coll Cardiol
Background Pericardial effusion could manifest as a loculated cyst on cardiac imaging. Anakinra (Interleukin-1 receptor antagonist) is showing promising results for treating recurrent resistant pericarditis. Case A 24-year-old male with no medical history presented with pleuritic chest pain after flu-like symptoms. He notes 3-4 similar episodes in past few years. Workup revealed diffuse ST elevations on EKG and a new right middle lobe opacity on chest X-ray. Chest CTA showed a pericardial cyst corresponding to the opacity seen on radiograph. No pericardial cyst or effusion was identified on echocardiogram. Further testing resulted in a positive rhinovirus/enterovirus PCR with unremarkable autoimmune workup. Decision-making Outpatient Cardiac MR to follow on the pericardial cyst was completed 6 weeks after the initial presentation. Interestingly, an interval resolution of the pericardial cyst seen on the prior CT chest noted. Patient endorsed recurrent symptoms with doubling of colchicine dose and resuming non-steroidal agents. He continued to have pericarditis flares, and a short course of prednisone was added. Eventually, patient was started on Anakinra, in addition to colchicine and ibuprofen, with improvement in symptoms. Conclusion Loculated pericardial effusion could mimic a pericardial cyst. Clinical correlation is imperative. Interleukin-1 receptor antagonists could result in symptomatic relieve in patients suffering from recurrent persistent pericarditis.