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.