Korean Circ J.  2009 Jul;39(7):288-291. 10.4070/kcj.2009.39.7.288.

A Case of Postcardiac Injury Syndrome Presenting as Acute Mediastinitis

• Lim HK
• Bae YP
• Lee BD
• Kim BG
• Park JH
• Kim JH
• Jang JS

• KMID: 2145565
• DOI: http://doi.org/10.4070/kcj.2009.39.7.288

Abstract

A 41-year-old man sought evaluation at the emergency department for pain in the anterior chest that had been ongoing for approximately 35 hours. The electrocardiogram showed marked ST segment elevation in the precordial leads. Cardiac biomarker levels were elevated. He subsequently underwent coronary angioplasty and stenting of the left anterior descending artery using two sirolimus-eluting stents. The following day, the patient complained of severe pain in his chest and shoulders. Computed tomography (CT) of the chest showed small gas bubbles around the aortic wall and mild pericardial thickening with subtle air densities, suggesting acute mediastinitis. With an impression of postcardiac injury syndrome and acute mediastinitis, he was treated with intravenous antibiotics and oral ibuprofen. Two days later, the patient had subjective improvement and the friction rub was no longer heard.

Keyword

Mediastinitis; Myocardial infarction

MeSH Terms

Adult
Angioplasty
Anti-Bacterial Agents
Arteries
Electrocardiography
Emergencies
Friction
Humans
Ibuprofen
Mediastinitis
Myocardial Infarction
Shoulder
Stents
Thorax
Anti-Bacterial Agents
Ibuprofen

Figure

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  Fig. 1 Electrocardiogram (ECG) showed marked ST segment elevations in the precordial leads.

• 

  Fig. 2 Left coronary angiogram showed total occlusion of the left anterior descending artery (arrow) (A) and the lesion was treated with two sirolimus-eluting stents (B).

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  Fig. 3 Axial (A and B) and coronal (C and D) CT images of the chest showed a soft tissue density lesion surrounding the ascending aortic wall and subtle streaky fatty infiltrations with a small gas bubble (arrow), and also showed pericardial thickening and a subtle air density, suggesting acute mediastinitis with aortitis and acute pericarditis. A small bilateral pleural effusion with basal lung atelectasis was also noted.

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  Fig. 4 A follow-up chest CT (coronal view; A, B and D and axial view; C) showed that the previously noted soft tissue density lesion surrounding ascending aortic wall and subtle streaky fatty infiltrations with a small gas bubble had resolved. However, multiple low density nodules (arrow) were found in the apex of the left ventricle, suggesting acute thrombi.

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