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Updated: Mar 30, 2026

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
"Amber in chamber" an enigmatous right atrial mass in a neonate
Sanjay Kumar1, Jai Prakash Sharma2, Saurabh Saigal3
1Department of Anesthesia, AIIMS, New Delhi, India.
Abstract:
The incidence of fungal infection is increasing worldwide. Although fungal infection is common in adults, few cases have been reported in the neonatal population. We report a case of the preterm neonate of 34 weeks who developed respiratory distress on 2(nd) day and was initiated on mechanical ventilation. Treatment was instituted for sepsis, but the patient continued to deteriorate. Two-dimensional echocardiography revealed a large right atrial mass, which eventually turned out to be fungal ball. Intense surgical and medical management led to a speedy recovery of the patient. We stress on the early use of echocardiography in atypical presentation of neonatal septicemia along with routine investigations to help in early recognition of source of infection. This can be of great value in initiating definitive management and improving survival rate in such patients.
Insights
Neonatal fungal infection is rare but serious. Early echocardiography in preterm infants with sepsis can reveal fungal balls, enabling prompt treatment and improving survival rates.
Area of Science:
- Neonatology
- Pediatric Infectious Diseases
- Medical Mycology
Background:
- Fungal infections are increasingly prevalent globally, yet uncommon in neonates.
- Preterm neonates present unique challenges for diagnosis and management of infections.
Observation:
- A 34-week preterm neonate developed respiratory distress and sepsis despite treatment.
- Echocardiography identified a large right atrial mass, later confirmed as a fungal ball.
Findings:
- The fungal ball in the right atrium was the source of the severe neonatal septicemia.
- Prompt surgical and medical intervention led to the neonate's rapid recovery.
Implications:
- Echocardiography is crucial for diagnosing atypical neonatal septicemia, especially in preterm infants.
- Early identification of fungal infections via echocardiography can significantly improve patient outcomes.
- This case highlights the importance of considering fungal etiologies in refractory neonatal sepsis.
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