Not Quite Pericarditis

Figure 1 (A-D)
Figures A - D: Not Quite Pericarditis
A 70-year-old man presented with sudden onset pleuritic chest pain and inferolateral ST-segment elevation on electrocardiogram via a primary percutaneous coronary intervention service. He had gastric cancer, palliated with radiotherapy. Coronary angiogram showed unobstructed arteries and a radiolucent pericardial space with a craggy surface (A). On echocardiography there were only sub-costal windows, which showed a pericardial effusion containing mobile echo-bright densities, no tamponade, and thickening around the right atrium consistent with malignant infiltration (B). Contrast-enhanced computed tomography (CT) showed hydropneumopericardium (C) and a fistulous tract between the gastric fundus and pericardial space (D).

What was the cause of this patient’s acute onset of chest pain?

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