CTICasesPeri-myocarditis Following PFO Closure Device Removal
Imaging findings
Following minimally invasive removal of an atrial septal closure device placed for a presumed patent foramen ovale, the patient developed pericarditis with a large pericardial effusion. Repeat imaging months later again showed pericardial fluid with intense inflammation, demonstrated by marked hyperenhancement on delayed gadolinium imaging of the pericardium, with associated epicardial myocardial involvement along the left ventricle and a predominantly left-sided pleural effusion.
Key takeaways
Despite prolonged anti-inflammatory therapy the pericarditis did not resolve, ultimately requiring pericardiectomy. The pattern represents peri-myocarditis, in which primary pericardial inflammation, presumably an immune reaction related to the prior device and surgery, secondarily involves the adjacent myocardium, the reverse of the more common scenario where myocarditis causes reactive pericarditis. A predominantly left-sided pleural effusion accompanying a pericardial effusion was noted as a helpful clue favoring pericardial disease over heart failure, which more typically causes a right-greater-than-left effusion.
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