The
patient underwent further workup. Chest x-ray (CXR) showed no focal
pulmonary consolidation, cardiac enlargement or pericardial
calcification. Inflammatory markers including erythrocyte sedimentation
rate (ESR), C-reactive protein (CRP), and high-sensitive C-reactive
protein (hs-CRP) were elevated. High-sensitivity troponin and brain
natriuretic peptide (BNP) levels were within normal limits. A 12-lead
electrocardiogram (ECG) demonstrated normal sinus rhythm. Echocardiogram
displayed diastolic septal bounce and the presence of mild constrictive
physiology with annular reversal (Figure 1) .
Cardiac magnetic resonance imaging (CMR) identified mild pectus
deformity (Haller Index: 3.6) and mild late gadolinium enhancement (LGE)
in the absence of pericardial edema (Figures 2,3,4) .