INSIGHTS IN IMAGES: CASE REPORT Acute Pericarditis in a 12-Year-Old Girl Figure 1. M .J. is a 12-year-old African American female who present- ed with trouble “taking a breath” which was abrupt in onset, starting two hours prior to presenting and accom- panied with abdominal pain and fatigue which resolved prior to her visit. Dyspnea was constant and not related to position. There were no alleviating or aggravating factors. Physical: t-98.7, p74, rr12, bp 98/60, o2 sat 97% ra Resp: ctab no crackles or wheezes Cor: rrr, no m/r/g were appreciated Diagnostic testing: CXR revealed a normal mediastinal silhouette, clear lung fields with no consolidation, effusion or pneumoth- orax. All other structures intact. EKG is shown for your review (Figure 1). Observations and Findings Patient was alert and in no distress and spoke in full sentences. Pmhx: bronchitis one year prior; no asthma, no cardiac prob- lems, no sickle cell disease Meds: none Social hx: no drugs or tobacco Ros: no fever, lethargy, headaches, chest tightness, cough, wheezing, foreign body aspiration, abd pain, vomiting, back pain, dysuria, polyuria, polydipsia, rashes, swollen glands, extremity pain, falls, or injuries 20 Diagnosis Acute pericarditis was determined by EKG, which reveals sinus rhythm with sinus arrhythmia, and diffuse ST segment eleva- tion in at least two limb leads and all chest leads, especially v3- v6. Lastly, no ST-segment reciprocal changes, no Q-wave fea- tures, and T-waves are prominent and upright. Discussion Pericarditis is an acute or chronic inflammation of the pericardi- JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | D e c e m b e r 2 0 0 6 w w w. j u c m . c o m