We present the case of an unusual presentation of Dressler’s syndrome and the important role of new imaging techniques in its diagnosis. A 42-year-old man was admitted with progressive dyspnoea and pleuritic chest pain during the last two months. Physical examination showed signs of hemodynamic instability (BP 75/40, HR 120 bpm). X-Ray showed cardiomegaly and electrocardiogram was suggestive of chronic anterior myocardial infarction. Transthoracic echocardiography showed pericardial effusion with signs of hemodynamic compromise. Emergent cardiac surgery was performed with suspicion of cardiac rupture. Only fibrinous material and serous fluid was found. 72 hours later he required reoperation because of recurrence of cardiac tamponade. Pleuropericardial window was made. Anti-inflammatory treatment was initiated. At discharge a magnetic resonance imaging study was performed. Diffuse pericardial inflammation consistent with a diagnosis of Dressler’s syndrome (DS) was demonstrated in T2- weighted black-blood and late enhancement sequences. One month later neither pleural nor pericardial effusion had recurred. Postinfarction pericardial effusions are common and magnetic resonance imaging has proven useful in determining its aetiology.
1956 William Dressler characterized a syndrome consisting of low-grade fever, pleuritic chest pain, pericardial friction rub and/or a pericardial effusion that rarely leads to cardiac tamponade. The symptoms tend to occur several weeks post myocardial infarction. Dressler’s syndrome (DS) is also known as post-myocardial infarction syndrome (PMIS) and since the introduction of reperfusion its incidence has drastically decreased. Magnetic resonance imaging (MRI) may be useful when trying to establish the etiology of post-myocardial infarction pericardial effusion.
We present the case of a 42-year-old man with progressive dyspnoea, pleuritic chest pain and low-grade fever during the last two months. He was admitted with evident signs of hemodynamic instability (BP 75/40, HR 120 bpm). Levels of troponin and creatine kinase were normal. Leucocytes were 24.100/mL (PMN 87%), PCR 28 mg/dL, creatinin 1.9 mg/dL and INR blood test 1.45. X-Ray showed cardiomegaly and unilateral pleural effusion (
pericardial effusion (
Dressler’s syndrome (DS), or post-myocardial infarction syndrome (PMIS), is a secondary form of pericarditis that occurs in the setting of injury to the heart. The postcardiac injury syndrome (PCIS) is characterized by inflammation
of the pericardium, pleura and pulmonary parenchyma following a variety of cardiac injuries, and includes not only DS, but also postpericardiotomy syndrome (PPS) and it has been described following cardiac surgery, blunt chest trauma, percutaneous left ventricle puncture, implantation of a pacemaker, coronary angioplasty and radiofrequency ablation [
Dressler first described it in the 1950s as an uncommon complication of myocardial infarction. The syndrome consisted of one or more of these features: pericarditis, pleuritis and pneumonitis [
In the last 50 years the incidence of DS has decreased from 5% to 0.5% [
DS consists of vague symptoms such as persistent fever, chest pain and dyspnoea. For diagnosis the following tests may be useful: in the laboratory tests stands out raised white blood-cell count and CRP, decreased C3 levels, presence of autoantibodies (antiheart, antiactin and antimyosin) and pleural and pericardial fluid analysis consistent with exudative fluid; electrocardiogram may present unusual evolutionary course showing ST segment reelevation; chest X-ray is abnormal in 95% of cases and pericardial effusion may be detected by echocardiogramphy [
DS is typically treated with NSAIDs such as aspirin, and only with corticosteroids or colchicine if it is resistant to treatment [
This case illustrates another clinical context where MRI may be useful when trying to establish the etiology of post-myocardial infarction pericardial effusion.