Introduction:
ST elevations on EKG have a broad differential diagnosis that can vary
from benign to more ominous pathologies. These include early
repolarization, coronary vasospasm, acute pericarditis, ST-elevation
myocardial infarction, ventricular aneurysms, and dissecting aneurysm of
the aorta reaching the pericardium. (1-50 The presentation of these
diseases can closely resemble SPM, in which patients often present with
sudden onset chest pain and shortness of breath. Furthermore, the
clinical scenario in patients with underlying SPM can pose a diagnostic
challenge due to ST-T changes on EKG that may mimic acute coronary
syndrome. (6-8) These EKG changes associated with SPM have seldom been
reported in the literature. We describe two SP cases with concomitant
pneumopericardium that closely mimics acute pericarditis with a
deceptive clinical spectrum.