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Postpericardiotomy Syndrome
Dressler’s Syndrome/Postmyocardial Infarction Syndrome/ Postcardiac Injury Syndrome

General Considerations

  • Autoimmune and febrile illness that can follow coronary artery bypass surgery
  • May also be seen following myocardial infarction (Dressler’s syndrome)
  • Reported to occur in 10-40% of cases
  • Combination of pericarditis, pleuritis and pneumonitis
  • Believed to have immunologic cause
  • Possibly a latent viral infection may be involved in cause

Clinical Findings

  • Symptoms typically appear 2-3 weeks following infarct/surgery–sometimes years
    • May last for weeks or months
  • Pleuritic chest pain (91%)
  • Fever
  • Pericardial and pleural effusion
    • Pericardial friction rub
    • Effusions can be bloody and cause tamponade
  • Also rales
  • Shortness of breath
  • Leukocytosis

Imaging Findings

  • Diagnosis can usually be made from a combination of the clinical picture and chest radiographs (95% abnormal)
  • Cardiac silhouette enlargement from pericardial effusion and mild to moderate-sized left (usually) pleural effusion
    • Pleural effusion may be bilateral
  • Pleural effusions (83%)
  • Parenchymal opacities (74%)
  • Enlarged cardiac silhouette from pericardial effusion (49%)

Differential Diagnosis

  • Different from more common post myocardial infarction reactive changes
    • Occurs between days 2 and 4 after the infarction
  • Congestive heart failure
  • Pneumonia
  • Reaction to medication

Treatment

  • High dose aspirin
  • Steroids

Postpericardiotomy Syndrome. Left: Immediately after coronary artery jump graft surgery, there are small bilateral effusions. Right:Three weeks later, there is a moderately large left pleural effusion (white arrow). There are no other signs of congestive heart failure.
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dressler syndrome

Three sequential images of the chest show a pre-op chest in which the left lung base is clear (green arrow); on the third day post-op coronary artery jump bypass surgery, there is subsegmental atelectasis at the left base (yellow arrow); Four weeks later, there is a left pleural effusion and subsegmental atelectasis visible (red arrow)


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