A 55-year-old man presents with pleuritic chest pain relieved by leaning forward. Auscultation reveals a pericardial friction rub. If the underlying inflammatory exudate fails to resolve, the likely outcome is:

• A Complete restoration of normal pericardial architecture
• B Progression to caseous necrosis of the pericardium
• C Transformation into a purulent empyema
• D Organization with fibrous adhesions between the visceral and parietal pericardium ✓

Explanation

The clinical picture is acute fibrinous pericarditis, in which a plasma protein rich exudate deposits fibrin on both pericardial surfaces, producing the friction rub. When fibrin cannot be cleared by plasmin because of extensive injury or persistent inflammation, macrophages grow into it and fibroblasts lay down collagen, a process called organization, leaving fibrous adhesions or constrictive pericarditis. Empyema requires a suppurative bacterial exudate, and caseation implies granulomatous infection such as tuberculosis.

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.