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Case Reports
. 2025 Jul 30;30(21):104436.
doi: 10.1016/j.jaccas.2025.104436.

Cholesterol Pericarditis

Mohammad Saquib Alam  1 , Khwaja Saifullah Zafar  2
Affiliations
Case Reports

Cholesterol Pericarditis

Mohammad Saquib Alam et al. JACC Case Rep. .

Abstract

Background: Cholesterol pericarditis is a rare condition characterized by cholesterol crystal accumulation in the pericardium, often linked to hyperlipidemia and chronic inflammatory disorders.

Case summary: A 50-year-old woman with a history of hypercholesterolemia presented with progressive dyspnea, chest pain, and fatigue. Clinical evaluation and imaging studies revealed a massive pericardial effusion. Pericardiocentesis was performed, and fluid analysis demonstrated the presence of cholesterol crystals. The patient was treated with pericardiocentesis, nonsteroidal anti-inflammatory drugs, and lipid-lowering therapy, leading to rapid symptom resolution.

Discussion: Cholesterol pericarditis remains an underrecognized cause of pericardial effusion. A high index of suspicion is required in patients presenting with unexplained pericardial effusion. Diagnosis is primarily based on pericardial fluid analysis. Management includes symptomatic relief with pericardiocentesis, anti-inflammatory therapy, and long-term lipid control to prevent recurrence.

Take-home messages: Cholesterol pericarditis should be considered in patients with unexplained pericardial effusion and dyslipidemia. Early diagnosis and treatment can lead to favorable outcomes.

Keywords: dyslipidemias; echocardiography; electrocardiogram; pericardial effusion.

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Conflict of interest statement

Funding Support and Author Disclosure The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Electrocardiogram and Chest X-Ray Before and After Pericardiocentesis (A) Electrocardiogram before pericardiocentesis demonstrates low-voltage QRS complexes and electrical alternans, indicating a significant pericardial effusion. (B) Electrocardiogram after pericardiocentesis shows normalization of QRS voltage and resolution of electrical alternans following drainage of the pericardial effusion. (C) Chest x-ray before pericardiocentesis reveals a massive pericardial effusion causing an enlarged cardiac silhouette and blunted costophrenic angles. (D) Chest x-ray after pericardiocentesis shows significant reduction in cardiac silhouette size and improvement in lung fields following pericardial fluid drainage.
Visual Summary
Visual Summary
Cholesterol Pericarditis: Diagnostic and Therapeutic Snapshot ECG = electrocardiogram; NSAID = nonsteroidal anti-inflammatory drug.
See this image and copyright information in PMC

References

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