A 50-year-old man with chronic kidney disease develops chest pain worse on lying down. Pericardiectomy specimen shows shaggy fibrin deposits on both visceral and pericardial surfaces. If the exudate is not resolved, what is the most likely outcome?

• A Complete restitution of the serosal surface
• B Organization with fibrous scar and possible adhesions ✓
• C Transformation into a purulent empyema
• D Caseous necrosis of the pericardium

Explanation

This is fibrinous inflammation, classically seen in uremic and rheumatic pericarditis, producing the bread and butter appearance. Fibrin-rich exudates are generally not fully resolved because fibrin lacks an efficient local fibrinolytic pathway; macrophages instead organize the exudate by ingrowth of fibroblasts and vessels, leaving fibrous adhesions that can cause constrictive pericarditis. Purulence requires abundant neutrophils and pus formation.

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.