Diffusely Elevated ST Segments on Electrocardiography.

A man in his early 70s walked into the emergency department with a 4-day history of fever and tingling sensation in the chest.Hismedical historywas significantwithhypertension, intracranial hemorrhage, and chronic kidneydisease (CKD).Onarrival, his bloodpressure was 130/64 mm Hg, heart rate was 104 beats/min, respiratory rate was 32 breaths/ min, body temperature was 37.1°C, and arterial oxygen saturationwas95%on roomair. Therewasnomurmur, rub, or gallop in chest auscultation. Electrocardiographic (ECG) findings were significant for diffuse STsegment elevation (Figure 1, A). Laboratory examination revealed leukocytosis with normalcardiacenzymelevelsandmildrenaldysfunction(serumcreatinine, 1.4mg/dL[toconvert tomicromoles per liter, multiply 88.4]). The C-reactive protein level was also elevated. He was admitted to the hospital with the suspected diagnosis of acute pericarditis. After admission, his chest discomfort resolved in 2 days, but he was still febrile, and pericardial effusiondid not decrease. Computed tomography (CT) of the chestwasperformed (Figure 1, B and C). Quiz at jamacardiology.com Electrocardiography at initial presentation A Unenhanced computed tomogram B