Airway Compression Resulting From Massive Pericardial Effusion and Tamponade.

SESSION TYPE: Critical Care Student/Resident Case Report Posters IPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: 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: 261-2632) Kuhn B, Peters J, Marx GR, Breitbart RE, Etiology, Management and Outcome of Pediatric Pericardial Effusions, Pediatric Cardiology 2008; 29: 90-94DISCLOSURE: The following authors have nothing to disclose: Ashley Meekin Johnson, Najmul Salman, Charles Gaymes, Andrew RivardNo Product/Research Disclosure InformationUniversity of Mississippi Medical Center School of Medicine, Jackson, MS.