This 33 male patient gave a history of recent travel 3 months of fevers, shoulder tip pain, and recent travel in South-East Asia. The axial CT image above shows pericardial effusion and enhancing pericardium. There is also a left pleural effusion. There were some non-enlarged but enhancing paracardiac lymph nodes, and evidence of right heart failure with IVC enlargement and periportal oedema.

A pericardial biopsy was performed which showed nonspecific fibrinopurulent pericarditis, with no evidence of malignancy. Cytology on the pericardial fluid showed only inflammatory cells. A Mycobacterium tuberculosis polymerase chain reaction test was negative. Culture for TB is negative to date.

The causes of fibrinous pericarditis include: viral; acute idiopathic; tuberculous; pyogenic; acute rheumatic fever; myocardial infarction; chronic renal failure; connective tissue diseases; malignant neoplasms (lymphoma, thymoma, mesothelioma, metastases); cardiac trauma or surgery; and radiotherapy.

Reference: Chandrasoma P, Taylor CR. Concise Pathology, 3rd edition. Lange 1998.

Credit: Dr Laughlin Dawes