A 59-year-old female was admitted with tachycardia and atypical chest pain. Physical examination was normal. The initial electrocardiogram (ECG) showed atrial fibrillation with a heart rate of 140/min. Laboratory results on admission were unremarkable except for a markedly elevated C-reactive protein of 180 mg/dL (normal value< 5 mg/dL). Troponin T levels on admission and follow-up were negative. A follow-up ECG after 4 h documented a spontaneous conversion in sinus rhythm and normal ST-segments. Echocardiography showed a normal left ventricular function (ejection fraction 60%) with no regional wall-motion abnormalities. A small circular pericardial effusion was noted. Additional laboratory tests revealed an acute parvovirus B19 infection by detecting parvovirus B19-specific IgM antibodies in the serum.

Cardiac magnetic resonance (CMR) imaging was scheduled to rule out acute myocarditis. A thickened pericardium (5.5 mm) and a small pericardial effusion were noted at cine-imaging (Panel A). At T2-weighted imaging (Panel B), a hyperintense signal from the thickened pericardium was noted suggesting pericardial oedema. No signs of myocardial oedema were present. Ten minutes after contrast administration of 0.2 mmol/kg gadolinium–DTPA inversion recovery, CMR revealed bright hyperenhancement of the complete pericardium (Panels C and D). No foci of delayed enhancement in the myocardium were noted.