Bloody pericardial tamponade in a child treated for pneumonia mimiking a lung tumor and infiltration of the heart

Abstract

We present the dramatic course of a female 5-year-old child with pneumonia and symptoms similar to local compression of the pericardium by a tumorous mass originating from the left lung. The child was treated with antibiotics for pneumonia with bilateral pleural effusions that required chest drainage. On the 10th day of therapy there was sudden anemia observed with the echocardiographic finding of acute cardiac tamponade. The child was referred for emergency life-saving surgical intervention. The chest was opened via a minimally invasive mini-incision in the area of the xiphoid process and bloody tension pericardial effusion was evacuated. The laboratory and histopathology investigations were not specific for neoplastic disease or tuberculosis infection. In the further observation the girl recovered and was discharged home two weeks after tamponade drainage. Fortunately our initial suspicion of neoplastic disease was not proved; nevertheless we would like to emphasize the need for oncologic vigilance in similar cases.

Minimally invasive transxiphoid approach for management of pediatric cardiac tamponade - one center's experience.

“…Nevertheless its clinical course can be a challenge for diagnostics and therapy, which need meticulous clinical examinations and vigilance to prevent oversight of potentially hazardous symptoms and terminal diseases. Acute tamponade, especially with bloody fluid, always requires oncological diagnostics of potential neoplastic growth [ 5 , 6 ].…”

“…The groups reported number from 10 to 14 patients, while the adult papers analyze hundreds of cases in particular adult centers [ 4 ]. There are some reports of acute bloody pericardial tamponade in immunocompetent children due to viral infection [ 5 ] or general sepsis. Similar reports present children with rapid pericardial tamponade; most of them are patients with circulatory insufficiency due to heart failure, infections, mediastinal neoplasms and local compression or trauma of the heart [ 7 – 9 ].…”

“…That corresponds with available contemporary literature reports and emphasis evolving role of miniinvasive techniques in selected group of patients [ 11 – 15 ]. In patients with a previous history the procedure was the turning point for continuation of therapy, as well as for precise histopathological diagnosis and subsequent modification of the further strategy of care [ 5 , 16 , 17 ].…”

Mediastinal dermoid cyst with rupture in the pericardium

“…When symptomatic there is a wide variety of presentations. They can present with dyspnoea, cough and fever due to compression of the trachea, bronchus or lung [ 3 ]. Compression of the superior vena cava and erosion of the bronchus can also occur.…”