A 52-year-old man on hemodialysis presents with chest pain worse on lying down. Auscultation reveals a pericardial friction rub. Pericardiectomy specimen shows a shaggy, red-brown epicardial surface resembling buttered bread. Microscopy would show:

• A Dense neutrophilic infiltrate with liquefactive necrosis
• B Granulation tissue with proliferating fibroblasts and capillaries
• C Eosinophilic meshwork of fibrin with entrapped inflammatory cells ✓
• D Well-formed non-caseating granulomas with epithelioid cells

Explanation

Uremic pericarditis is the classic example of fibrinous inflammation: severe injury increases vascular permeability so markedly that large molecules like fibrinogen leak out and form an eosinophilic fibrin meshwork, giving the gross 'bread and butter' appearance. Suppurative inflammation with liquefactive necrosis defines an abscess, and granulomas are seen in tuberculosis or sarcoidosis, neither of which fits this setting.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.