274 A FLOATING HEART IN AN EXCAVATED CHEST

Abstract Pericardial effusion is a common finding in clinical practice either as incidental or manifestation of systemic cardiac disease. The spectrum pericardial effusions ranges from mild asymptomatic to tamponade. Etiology one the main factors determining patient's prognosis. However, most cases effusion, even if large, remains unknown origin. Pectus excavatum (PEX) deformity chest wall which inferior part sternum and cartilage are displaced posteriorly. PEX present within first year life affected children, more frequently boys than girls. may lead compression right-sided cavities between vertebral column impacting right ventricular anatomy rendering assessment by echocardiography very difficult. diagnosis generally confirmed but its etiology be Although many idiopathic, careful review medical history, physical examination, laboratory tests can reveal patients. causes infections, malignant tumors, connective tissue diseases, injury syndrome, myocardial disease, uremia. In last years, an association idiopathic has been hypnotized. We report 2 athletes, 15 18 years old, who came our attention for post COVID19 infection evaluation indicated ministerial "Return Play" protocol. Physical examination was negative any signs/symptoms. Resting ECG showed normal sinus rhythm. Stress test performed resulted signs symptoms reduced coronary reserve arrhythmias. echocardiographic moderate-severe 20 mm mm, absence hemodynamic alteration. Blood were (including CRP, ESR, blood count, D-Dimer, IL-6, uricemia) normal. CardioRM presence severe without impairment/instability. Holter-ECG, during training session, arrhythmic events. Athletes followed up with six-monthly echocardiographic, HolterECG stress evaluations, unchanged entity arrythmia at serial controls. Chronic active inflammation represent diagnostic therapeutic challenge, especially later COVID-19 disease vaccination associated injury. effusion. interest, caution should used before labeling indiscriminately due PEX, when insights suggesting alternative present, such neoplasm tuberculosis, instability present. On contrary, otherwise occasionally identified patient both referring physician reassured benign these two entities, proper setting.