A 59-year-old woman on hemo-dialysis because of renal failure due to lithium nephrotoxicity is admitted to hospital with acute anterior chest pain:

• Sinus rhythm
• Acute pericarditis

This patient has bipolar and manic depression and during the previous 10 days failed to show-up for hemodialysis. On admission she had a loud pericardial friction rub. She developed a large pericardial effusion. She was treated with aggressive dialysis and her chest pain and pericardial effusion gradually improved.