Acute Isolated Viral Pericarditis With Rapid Progression to Constrictive Pericardial Disease

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A previously healthy 42-year-old man presented with fatigue and progressive dyspnea 6 weeks after an episode of massive diarrhea that required supportive intravenous therapy. A chest x-ray showed bilateral pleural effusion and echocardiography demonstrated extensive pericardial effusion, whereas global systolic right and left ventricular function appeared preserved (Figure 1A). Figure 1. Echocardiographic still frames of a four-chamber view at endsystole. (A) During initial presentation, extensive pericardial effusion (white arrow) and a “swinging heart” pattern were seen. (B) Six months later, paradoxical motion of the interventricular septum and an echo-intense pericardium were found (white arrowheads). The patient was referred to cardiac magnetic resonance imaging for suspected inflammatory involvement of the myocardium; cardiac magnetic resonance imaging demonstrated acute inflammation confined to the visceral and parietal pericardial layers (Figure 2A through …