Definition/General
Introduction:
Viral pericarditis is viral infection of pericardium
Most common cause of acute pericarditis
Common viruses: Coxsackievirus B, Echovirus, Adenovirus
Self-limiting in most cases
Good prognosis overall.
Origin:
Direct viral infection of pericardium
Post-viral immune response
Molecular mimicry
Systemic viral illness with pericardial involvement.
Classification:
Based on virus: Enteroviral (Coxsackie, Echo)
Adenoviral
Influenza
EBV, CMV
COVID-19 associated.
Epidemiology:
Most common cause of acute pericarditis
Young adults predominantly affected
Male predominance
Seasonal variation (fall, winter).
Clinical Features
Presentation:
Sharp chest pain
Pericardial friction rub
ECG changes (ST elevation)
Viral prodrome
Self-limiting course.
Symptoms:
Chest pain (95% cases)
Fever (70% cases)
Malaise (60% cases)
Myalgia (50% cases)
Upper respiratory symptoms (40% cases).
Risk Factors:
Recent viral illness
Young age
Immunocompromised state
Seasonal exposure.
Screening:
ECG
Echocardiography
Viral serology
PCR studies.
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Microscopic Description
Histological Features:
Lymphocytic predominance (70-90%)
Activated lymphocytes
Plasma cells
Reactive mesothelial cells
No neutrophils.
Cellular Characteristics:
Small lymphocytes
Large activated lymphocytes
Plasma cells with eccentric nuclei
Reactive mesothelial proliferation.
Architectural Patterns:
Dispersed lymphocytes
No granulomatous inflammation
Clean background
Mesothelial hyperplasia.
Grading Criteria:
Normal or mildly elevated protein
Normal glucose
Normal ADA levels
Viral PCR positive.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Pericardial fluid, volume [X] mL, clear to slightly turbid
Cell Differential
Lymphocytes: [X]% (70-90%), Mesothelial cells: [X]%, Neutrophils: [X]% (few)
Viral Studies
Viral PCR: [Results if available]
Final Diagnosis
Pericardial fluid consistent with viral pericarditis