(a) Twelve-year-old female with chest pain suggestive of pericarditis . (b, c) There is widespread concave ST elevation and PR depression. Reciprocal ST depression and PR elevation in lead aVR (with or without V1). As an ancillary but aspecific sign, there can be sinus tachycardia due to pain or pericardial effusion. (d) With healing, the ECG returned to normal

(a) Nine-year-old male with typical manifestation of pericarditis . (b) Widespread concave ST elevation and PR elevation in aVR . (c) The height of the ST segment elevation in the J point is compared to the amplitude of the T wave in V5: a ratio of >0.25 suggests pericarditis; a ratio of <0.25 suggests BER. (d) In some leads as in V4, the pattern looks like BER but the ratio is >0.25

(a) Ten-year-old male with acute pericarditis and mild pericardial effusion . ESR and CRP are elevated. Only leads I and aVR are suggestive, but not pathognomonic. (b) Close-up. The diagnosis of pericarditis remains a clinical and laboratory diagnosis

Low voltages in pericardial effusion . (a) Fourteen-year-old male with severe pericardial effusion . (b) Twenty-year-old woman with incidental finding of moderate to severe pericardial effusion. (c) Fifteen-year-old girl with severe pericardial and pleural effusion. (d) Eight-year-old male with pericardial effusion