Secondary pericarditis can occur following myocardial infarction; this is relatively common acutely between 2 and 4 days after myocardial infarction. In contrast Dressler's syndrome presents with a low-grade fever and chest pain 2 to 10 weeks after myocardial infarction, and is less common, affecting between 1 and 5% of patients [
1‐
4]. In Dressler's initial description the cause was hypothesised to be irritation due to the presence of blood in the pericardial space[
5], however several possible pathogenic mechanisms have been proposed since including; autosensitisation to myocardial antigens released into the circulation during infarction[
6], latent viruses[
7] or simply that the syndrome represents a prolonged and exaggerated form of early post-infarction pericarditis[
8]. Since the introduction of reperfusion, with thrombolysis and balloon angioplasty, the incidence of DS has decreased[
9,
10]. It is postulated that the diminution of the infarct size and the shortened time of exposure of myocardial antigens to the immune system may be responsible[
10]. However it has been suggested that the immunomodulatory properties of modern post-myocardial infarction drug therapies, such as ACE inhibitors, statins and B-blockers, may play a role[
11]. The clinical presentation can be classical, with pleuritic pain and an associated pericardial rub; however the differential diagnosis includes further acute coronary syndrome and pulmonary embolism which may result in the need for further diagnostic investigation. We describe a case where global pericardial inflammation late post-myocardial infarction is clearly demonstrated by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR).