Wednesday, December 9, 2015

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis

A young man was in a rollover Motor Vehicle Collision, with a chest laceration and chest pain.

He underwent a CT scan of the chest:
There is a very small pneumothorax anterior to the heart

This image is from slightly lower down:
There is a bit of air in the pericardium

A troponin returned elevated, so this ECG was recorded:
There is some minimal ST elevation in inferior and lateral leads.  This is consistent with percarditis.  The troponin shows that there is some myocardial damage.  Is it myocardial contusion, or myo-pericarditis?  Or pericarditis as a result of myocardial contusion?

6 hours later:
There is diffuse ST elevation without large T-waves (low T-wave to ST segment ratio, which is typical of pericarditis vs. STEMI).  There is PR depression.  There is also "Spodick's sign," (downsloping TP segment); whether this is or is not a highly accurate sign of pericarditis is uncertain.

The next morning
There is increased ST elevation

Troponin Profile:


  1. Replies
    1. Rajiv,
      This one is mostly a curiosity. No great learning points. Sorry!

  2. - .... T/ST ratio typical of Pericarditis vs.STEMI (?)
    - "generally" this ratio is know for Pericarditis versus Early repol.
    - in your opinion it is also valid for Pericarditis versus STEMI ??

    merci Dr Smith


    1. Yes. STEMI has larger T-waves and is a major differentiator between pericarditis and STEMI.

  3. Very nice. There is nice Spodick's sign and a typical DII > DIII elevation. I would guess that any inflammatory process (including post-trauma) can produce those images. Thanks!



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