{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:37:09Z","timestamp":1777855029238,"version":"3.51.4"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cholesterol pericardial effusion is a rare diagnosis and typically not associated with the development of pericardial constriction. However, covariate factors, such as Rheumatoid arthritis, myxoedema, and comorbid disease requiring anticoagulation, can predispose to developing dense adhesions that ultimately can cause pericardial constriction and constrictive physiology. This can develop without preceding symptoms but ultimately may declare itself with a variety of clinical presentations including syncope.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We present a patient with a pericardial mass incidentally identified during hospital evaluation after presentation with syncope. Initial suspicion based on computed tomographic angiography (CTA) appearance was of a pericardial cyst. Additional multimodal imaging consisting of transthoracic echocardiogram (TTE) and magnetic resonance imaging (MRI) supported evidence of a right ventricular\u2013compressive effusion with constrictive physiology, findings more suggestive of a loculated pericardial effusion than a pericardial cyst without evidence of pericardial inflammation. Although transoesophageal echocardiography (TEE) guided pericardiocentesis was technically successful, it failed to produce clinical or haemodynamic improvement of the pericardial constriction. Partial local pericardiectomy and cruciate incision of the anterior aspect of the rind was essential in relieving the constrictive process. Pathologic analysis of resected pericardium demonstrated cholesterol granuloma. We discussed the role of multimodal imaging in disease classification, as well as coexisting conditions such as rheumatoid arthritis and anticoagulation for pulmonary embolism that contributed to this case\u2019s unique presentation and timeline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case underscores the critical role of a multimodality imaging strategy in pericardial disease\u2014particularly in managing rare cholesterol loculated effusions\u2014and highlights how coexisting conditions can shape disease progression and treatment timing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag261","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T11:28:55Z","timestamp":1776166135000},"source":"Crossref","is-referenced-by-count":0,"title":["A cheesy exudate: a case report on management of pericardial disease through multimodal cardiac imaging"],"prefix":"10.1093","volume":"10","author":[{"given":"Aadavan","family":"Elangovan","sequence":"first","affiliation":[{"name":"University of Florida , College of Liberal Arts and Sciences, 330 Newell Drive, Gainesville, FL 32603 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4139-8580","authenticated-orcid":false,"given":"Thomas","family":"Lewandowski","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, University of Florida Health , 1600 SW Archer Rd, Gainesville, FL 32608 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5721-5819","authenticated-orcid":false,"given":"Dhaval","family":"Naik","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, University of Florida Health , 1600 SW Archer Rd, Gainesville, FL 32608 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6111-0743","authenticated-orcid":false,"given":"John","family":"Spratt","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, University of Florida Health , 1600 SW Archer Rd, Gainesville, FL 32608 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7950-7045","authenticated-orcid":false,"given":"Hussain","family":"Khalid","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, University of Florida Health , 1600 SW Archer Rd, Gainesville, FL 32608 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"2026042919190470800_ytag261-B1","first-page":"38","article-title":"Pericardial heart disease: Its morphologic features and its causes","volume":"18","author":"Roberts","year":"2005","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"2026042919190470800_ytag261-B2","doi-asserted-by":"crossref","first-page":"3952","DOI":"10.1093\/eurheartj\/ehaf192","article-title":"2025 ESC guidelines for the management of myocarditis and pericarditis","volume":"46","author":"Schulz-Menger","year":"2025","journal-title":"Eur Heart J"},{"key":"2026042919190470800_ytag261-B3","article-title":"Effusive-constrictive cholesterol pericarditis: a case report","volume":"5","author":"Shergill","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"2026042919190470800_ytag261-B4","doi-asserted-by":"crossref","first-page":"W621","DOI":"10.2214\/AJR.10.7265","article-title":"Cardiac MRI: part 2, pericardial diseases","volume":"197","author":"Rajiah","year":"2011","journal-title":"AJR Am J 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