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Purulent pericardial effusion in children: Experience from a tertiary care center in North India
Anika Agrawal1, Urmila Jhamb1, Arima Nigam2
1Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
Insights
Purulent pericarditis in children requires prompt management. Echocardiography-guided drainage is effective, while some cases respond to antibiotics alone, highlighting the need for timely intervention in pediatric purulent pericardial effusion.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Purulent pericarditis poses significant risks, with a lack of specific pediatric management guidelines.
- Timely recognition and intervention are crucial to prevent severe outcomes.
Purpose of the Study:
- To describe the management experience of 22 pediatric patients with purulent pericardial effusion over seven years.
- To evaluate treatment strategies and outcomes for this rare condition in children.
Main Methods:
- Retrospective analysis of hospital records for 22 children diagnosed with purulent pericardial effusion (2012-2018).
- Data included patient demographics, clinical presentation, associated infections, causative organisms, and treatment interventions.
Main Results:
- The average age was 4.6 years, with fever as the most common symptom.
- Staphylococcus aureus was the most frequent pathogen; empyema was a common co-infection.
- Pericardial drainage was performed in 59% of patients, with 27.2% responding to antibiotics alone. Mortality was 13.6%.
Conclusions:
- Echocardiography-guided percutaneous pericardiocentesis with pigtail catheter placement is safe and effective.
- Conservative management with close echocardiographic monitoring is suitable for small residual effusions when drainage is not feasible.
Background:
Purulent pericarditis, if not recognized and managed timely, it can lead to significant morbidity and mortality. There are no guidelines for the management of purulent pericardial effusion in pediatric patients.
Aim:
The study describes our experience with the management of 22 patients admitted with a primary diagnosis of purulent pericardial effusion seen over a 7-year period.
Materials And Methods:
Hospital records of 22 children admitted to the pediatric intensive care unit with purulent pericardial effusion during January 2012-December 2018 were retrospectively analyzed.
Results:
The mean age of presentation was 4.6 years. The most common presentation was fever. History of antecedent trauma was present in 27.27% of patients. Empyema was the most common associated infection. Staphylococcus aureus was the most commonly isolated organism. Out of 22, pericardial drainage was done in 13 patients (59%). Only one of these patients required pericardiectomy later on. Six (27.2%) patients responded to antibiotics alone. Three (13.6%) patients died before any intervention could be planned.
Conclusion:
Echocardiography-guided percutaneous pericardiocentesis and pigtail catheter placement are a safe and effective treatment for purulent pericardial effusion. When pericardial drainage is not amenable, close monitoring of the size of effusion by serial echocardiography is required. Small residual pericardial effusion may be managed conservatively.
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