대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Dressler (post-myocardial infarction) syndrome

Radiologic Findings

This patient presented with acute myocardial infarction. Initial chest radiograph (Fig. 1) shows no definite abnormal findings except known neurogenic tumor in posterior mediastinum. Axial CT image of the heart (Fig. 2) after administration of contrast medium shows low attenuation areas in lateral wall of left ventricle, and this is consistent with AMI. Follow-up chest radiograph after 10 days (Fig. 3) shows pleural effusion in left hemithorax but pleural effusion is complete resolved with self-limited on the last chest radiograph (Fig. 4).

The clinical findings were consistent with Dressler syndrome.

Brief Review

Dressler syndrome is an acute illness with fever, pericarditis, and pleuritis, possibly of autoimmune origin, that occurs weeks to months after an acute myocardial infarction. Dressler estimated with this syndrome occurred in up to 4% of patients after acute myocardial infarction, however, a more recent series from the same hospital indicates that the incidence of the Dressler syndrome has markedly decreased.

The cause of Dressler syndrome is unknown. The association of symptoms and the appearance of antimyocardial antibodies has led to the hypothesis that an autoimmune mechanism, with or without a latent viral infection, is the etiologic factor.

Patients characteristically have severe malaise, fever, chest pain and pleurisy.

The chest radiography commonly reveals an enlarged cardiac silhouette secondary to pericardial effusion associated with pleural effusions and, occasionally, transient pulmonary infiltrates.

A single episode of Dressler syndrome is usually self-limited, but the syndrome tends to recur. Patients with severe symptoms with fever and chest pain usually benefit from bed rest and treatment with aspirin or a nonsteroidal anti-inflammatory agent.

References

1. Dressler W.: The post-myocardial infarction syndrome. A report of forty-four cases. Arch. Intern. Med 103:28,1959.

2. Khan AH. : The postcardiac delayed injury syndrome. Clin. Cardiol. 15:67, 1992.

Keywords

Multiple organs, Non-infectious inflammation,