Friday, December 26, 2008


A 65 year old man who had an MI a month ago presents with chest pain upon deep inspiration as well as malaise. He received a coronary artery bypass for the MI. Currently, exam shows a temperature of 39, a pericardial friction rub, and leukocytosis. The sed rate is increased. Sequential radiographs are shown above.

Question: What is he currently suffering from?

Image shown under fair use.


Alex said...


CodeDog said...

Postoperative atelectasis and pneumonia

Stephanie said...

pericarditis with pericardial effusion?

Craig Chen said...

Yes, I think all those answers are correct.

This is Dressler’s Syndrome or postcardiac injury syndrome which occurs weeks to months after an MI. The pathogenesis is immunologic. The sequential radiographs show a pre-op clear lung (green arrow is clear left lung base), a post-op with segmental atelectasis at the left base (yellow arrow), and a left pleural effusion a month later (red arrow). A pleural or pericardial effusion is often seen in Dressler’s syndrome. Treatment is NSAIDs.

Sources: UpToDate; LearningRadiology.