SESSION TYPE: Critical Care Student/Resident Case Report Posters I
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Viral pericardial effusions, have not been reported to cause airway compression possibly as the fluid does not create a mass effect. In young children, external compression of the bronchi may be seen more frequently due to the softer cartilage of these airways. (1)
CASE PRESENTATION: A 5-month-old white female with an insignificant past medical history was admitted to an outside hospital with a low- grade fever of 10 days, labored breathing, and decreased appetite and urinary output. Upon day one evaluation by chest x-ray, the patient had an enlarged cardiothymic silhouette with diffuse hazy infiltrate in the left lung. Treatment was started for possible pneumonia. (Figure 2. A) The patient deteriorated with respiratory distress; on day three, a CT scan was ordered. CT scan was interpreted by radiology as: very large rounded mass involving the anterior mediastinum with airway compression. (Figure 2. C) The referring hospital transferred the patient. Upon arrival to the Batson Children's PICU, a bedside echocardiogram was performed immediately due to clinical exam findings. Massive pericardial effusion with tamponade physiology was confirmed. (Figure 1. A) Emergency pericardiocentesis was performed under local 2% lidocaine with sterile precautions. After pericardiocentesis, the patient’s condition improved markedly with resolution of respiratory distress. Echocardiogram, chest x-ray, and repeat CT scan were ordered upon completion of the procedure, which showed no compression of the primary bronchi and there was no impression of a mediastinal mass. (Figure2. B&D, Figure 1.B). Pericardial fluid was sent for analysis and revealed to be non- malignant. Viral studies, enterovirus and flu PCR, respiratory cultures, antinuclear antibodies, rheumatoid factor, TSH, and T4 were ordered to investigate etiology. All tests returned negative, except a stool swab positive for adenovirus.
DISCUSSION: In pediatric patients, massive pericardial effusion is often not linked to a causative agent; approximately 37% of cases of pericardial effusion are ultimately categorized as idiopathic disease. (2) We suspect the cause of our patient’s massive pericardial effusion was viral in etiology due to a stool swab positive for Adenovirus. We believe this is the first case report of a viral pericardial effusion in a previously healthy infant presenting as a mediastinal mass causing airway compression.
CONCLUSIONS: We suggest that when a diagnosis of mediastinal mass is made by chest X-ray or CT scan a possibility of pericardial effusion and cardiac tamponade should be investigated by obtaining an emergency echocardiogram in children.
1) Awad WI, Graves TD, White VC, Wong K, Airway Obstruction Complicating Mediastinal Tuberculosis: A Life-Threatening Presentation, Annals of Thoracic Surgery 2002; 74: 261-263
2) Kuhn B, Peters J, Marx GR, Breitbart RE, Etiology, Management and Outcome of Pediatric Pericardial Effusions, Pediatric Cardiology 2008; 29: 90-94
DISCLOSURE: The following authors have nothing to disclose: Ashley Meekin Johnson, Najmul Salman, Charles Gaymes, Andrew Rivard
No Product/Research Disclosure InformationUniversity of Mississippi Medical Center School of Medicine, Jackson, MS