Idiopathic right atrial enlargement with pericardial effusion.

antibodies to native DNA. A search of the literature revealed only two previously reported cases of constrictive pericarditis attributable to systemic lupus. Yurchak and co-workers5 described a patient who had systemic lupus manifested by malar rash, antinuclear antibodies, and LE cells at the time when constrictive pericarditis developed. However, he also had an atrial septal defect and rheumatic heart disease; an association between atrial septal defect and constrictive pericarditis has been reported.*-lo The second case1 was described very briefly, and the diagnosis of lupus was made retrospectively, in that LE cell preparations were found to be positive an unspecified period of time after pericardiectomy. The case described here represents a report of constrictive pericarditis in a patient with clinically active systemic lupus in the absence of other disorders. The rapidity with which constriction developed in this case was noteworthy. The time interval from onset of chest pain to clinical evidence of pericardial constriction was only seven weeks. Although corticosteroids relieved the symptoms of acute pericarditis, the development of constriction was apparently not inhibited. This case illustrates that constrictive pericarditis can be a manifestation of systemic lupus erythematosus, that it can develop quite rapidly, and that it may not be prevented by corticosteroid therapy. al: The cardio-vascular manifestations of systemic lupus erythematosus. An asymptomatic patient with idiopathic right atrial enlargement is described in whom the interesting feature was associated pericardial effusion; this association has not been reported previously. Both of these conditions had been present for 16 years and both remained non-progressive. I diopathic enlargement of the right atrium is a rare and perhaps a controversial clinical entity. Since the original description of Pastor and Forte1 in 1961, 15 cases have been reported in the English Originally, the condition was regarded as benign, but more recently, there have been reports of symptomatic patients who had massive enlargement of the right atrium associated with atrial dysrhythmias.2~4 There is one reported incidence of sudden death,6 and some patients have undergone exploratory thoramtomy unnecessarily .'*2,5 The condition of idiopathic enlargement of the right atrium probably occurs more frequently and is less benign than early communications implied. Accordingly, this report describes a patient with enlargement of the right atrium in whom the feature of special interest is chronic pericardial effusion. This association has not been described previously. A 26-year-old man was referred to the Mayo Clinic because of an abnormal cardiac silhouette on a routine …