Post-Cardiac Injury Syndrome — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGeneral Internal MedicinePost-Cardiac Injury SyndromeRACP Adult Medicine

A 45-year-old man develops dyspnoea and bilateral pleural effusions 6 months after cardiac surgery. Pleural fluid analysis shows an exudate with elevated ADA (adenosine deaminase). His ESR is elevated. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Parapneumonic effusion

Post-cardiac injury syndrome (PCIS) can occur weeks to months after cardiac surgery, MI, or cardiac procedures. It causes pericarditis, pleuritis, and fever. Pleural fluid is an exudate and can have elevated ADA (which is not specific for TB – also elevated in empyema, lymphoma, rheumatoid pleurisy, and PCIS). The temporal relationship with cardiac surgery is the key diagnostic clue. Treatment is with NSAIDs (ibuprofen or aspirin) plus colchicine. Corticosteroids are second-line (same as for pericarditis).

Reference: eTG – 2025 – Cardiovascular; ESC – 2015 – Pericardial Diseases Guidelines