[A girl with dyspnea and an enlarged liver]
Julia M J Van der Zande1,2, Ellen Vanhie1, Bart Straver1
1Amsterdam UMC, locatie AMC, afd. Kindergeneeskunde.
Insights
A child
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
Background:
- Children presenting with fever and respiratory symptoms during winter months often require emergency department visits.
- Influenza and Respiratory Syncytial Virus are common culprits during this season.
Observation:
- A 2-year-old girl presented with fever, dyspnea, and signs of heart failure.
- Echocardiogram revealed significant pericardial effusion with cardiac tamponade.
- Purulent fluid was drained via pericardiocentesis, but effusion recurred.
Findings:
- The patient underwent pericardiectomy to prevent constrictive pericarditis, leading to recovery.
- Cultures identified Haemophilus influenzae type b, treated with amoxicillin.
- This case highlights a rare cardiac complication of bacterial infection in children.
Implications:
- Fever and dyspnea in children can indicate serious cardiac conditions beyond respiratory illness.
- Echocardiography is crucial for diagnosing pericardial effusion and cardiac tamponade.
- Prompt diagnosis and appropriate treatment, including antibiotics and surgical intervention, are vital for managing pediatric pericarditis.
Background:
During winter, the influenza and Respiratory Syncytial Virus season, children are often seen in the emergency department with fever and respiratory symptoms.
Case Description:
We describe the case of a 2-year-old girl with fever, dyspnea and signs of heart failure during physical examination. Echocardiogram showed a large amount of pericardial effusion with signs of cardiac tamponade. Pericardiocentesis showed 200 ml purulent liquid. Surgical drainage was performed. However pericardial effusion recurred. Because constrictive pericarditis was feared, a pericardiectomy was performed after which the patient recovered. Cultures showed Haemophilus influenzae type b and the patient was treated with amoxicillin for 4 weeks in total.
Conclusion:
Fever and dyspnea may also be caused by a problem outside the respiratory system. With physical examination a cardiac cause, such as pericarditis, can be detected. An ECG is easily obtained and can help in the differential diagnosis. An echocardiogram can confirm the diagnosis.
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