Acute pericarditis is common but illusive, often mimicking acute coronary syndrome in its clinical and electrocardiographic presentation. Regional pericarditis, though rare, presents further challenge with a paucity of published diagnostic criteria. We present a case of postoperative regional pericarditis and discuss helpful electrocardiographic findings. A 66-year-old male with history of open drainage of a liver abscess presented with abdominal pain and tenderness. CT of the abdomen was concerning for pneumatosis intestinalis of the distal descending colon. He underwent lysis of liver adhesions; exploration revealed only severe colonic impaction, for which he had manual disimpaction and peritoneal irrigation. Postoperatively, he developed sharp chest pain. Electrocardiogram revealed inferior ST elevation. Echocardiogram revealed normal left and right ventricular dimensions and systolic function without wall motion abnormalities. Emergent coronary angiography did not identify a culprit lesion, and left ventriculogram showed normal systolic function without wall motion abnormalities. He received no intervention, and the diagnosis of regional pericarditis was entertained. His cardiac troponin was 0.04？ng/dL and remained unchanged, with resolution of the ECG abnormalities in the following morning. Review of his preangiography ECG revealed PR depression, downsloping baseline between QRS complexes, and reciprocal changes in the anterior leads, suggestive of regional pericarditis. 1. Introduction Prompt evaluation of an electrocardiogram (ECG) remains the basis for the initial workup and early implementation of life-saving therapy in patients presenting with chest pain suggestive of acute coronary syndrome (ACS). Vigilance, however, is recommended in the interpretation of the ECG, paying attention to atypical clinical or electrocardiographic features which may point at an alternative diagnosis, mandating further diagnostic studies and different management. We present a case of regional pericarditis with electrocardiographic features mimicking an inferior myocardial infarction, prompting early cardiac catheterization. Subtle ECG findings, however, can serve as clues to the presence of pericarditis rather than myocardial ischemia. Review of pertinent literature is provided. 2. Case Report A 66-year-old white male with known hypertension and diabetes mellitus and prior open drainage of a liver abscess presented to our emergency department with abdominal pain and tenderness. The patient underwent computed tomography (CT) scan of the abdomen which revealed
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