Acute Fibrinous Pericarditis

Clinical History

This patient was admitted to hospital with shortness of breath. Examination showed signs of congestive cardiac failure, cardiomegaly and a pericardial friction rub. He was treated with digitalis and Lasix but died soon after admission.


The pericardium has been opened to display its visceral and parietal layers and an enlarged heart. Both layers of pericardium are thickened and covered by a thick shaggy fibrinous exudate. This is an example of acute fibrinous ("bread and butter") pericarditis. The cause in this case is unknown.


There are a number of possible causes of acute fibrinous pericarditis, including myocardial infarction, uraemia, rheumatic fever, systems lupus erythematosis, irradiation of the chest, trauma and (rarely) infections. Rheumatic pericarditis is usually associated with acute rheumatic involvement of all layers of the heart, i.e. rheumatic myocarditis and endocarditis are likely to be present as well as a fibrinous pericarditis.