Dr. Ateendra Jha

Dr. A Jha is currently holding the president position at CHEARS. He has completed PharmD from Manipal University there after he worked as Product Manger in Eris then moved to Academics, as Asst. Professor. He also served as Academic Head in Research Institute, Chandigarh. He also acted as medical team member for an Investigational project sponsored by ICMR. He has guided / Co-Guided more than 10 academic Thesis ( Include candidates form Rajeev Gandhi University of Health Sciences and Punjab Technical University ). He also has guided more than 50 conference presentations. Quote : " You are successful only if Someone is successful because of you."

Clinical Challenge - 3

31 July 2020


A 69-year-old man with no prior medical history presents over the course of several months with new-onset nonspecific joint pain and swelling without evidence of erosions. The joints involved include his wrists, elbows, hands, and knees.

He was initially treated for presumed gout but was unresponsive.

Laboratory findings include:

  1. High-sensitivity C-reactive protein, 36 mg/L

  2. White blood cell count, 13.0 x 103 /µL

  3. Hemoglobin, 14 g/dL

  4. Hematocrit, 45 g/dL

  5. Thyroid stimulating hormone level, 1.13 U/mL

  6. Serum creatinine, 0.8 mg/dL

  7. Erythrocyte sedimentation rate, 19

  8. Rheumatoid factor was positive

A 2-dimensional echocardiogram before starting immunomodulators was performed, showing a poorly visualized pericardial structure in the subcostal view that appeared to be compressing the right ventricle.

Although cardiomyopathy, heart failure, mitral valve disease, and amyloidosis are among 3 conditions seen in rheumatoid arthritis, pericarditis is the most common cardiac manifestation that occurs.

In general, echocardiographic evidence of pericarditis precedes and often occurs more often than clinically significant pericarditis. However, patients with clinical manifestations of pericarditis are at higher risk for mortality and progression to pericardial constriction.

What is the next best imaging modality to further evaluate the abnormal structure described here?

A.         Transesophageal echocardiogram

B.         Chest X-ray

C.         Chest computed tomography scan

D.         No further imaging is necessary

Please drop your answer in comment box with justification.

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