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• W3206155983 abstract "A 14-year-old male was referred to the emergency department (ED) by his pediatrician for cough and cardiomegaly. His cough was non-productive, primarily nocturnal, had persisted for 3 weeks, and was exacerbated by eating and lying flat. Outpatient chest radiography revealed cardiomegaly (Figure 1). He was referred to the ED thereafter, where he was tachycardic, but normotensive. His examination was otherwise unremarkable, with normal heart sounds and lacking jugular venous distention (JVD). Pediatric cardiology recommended cardiac point-of-care ultrasound (POCUS), if available, with a tentative plan for discharge home and close outpatient follow-up. POCUS revealed a pericardial effusion (Figures 2 and 3). Formal echocardiography confirmed a large pericardial effusion and revealed evidence of tamponade physiology, including severe right atrial and mild right ventricular collapse (Figure 4 and Video S1) and varied flow velocities with respiration. Ultrasound-guided drainage of his effusion was performed under general anesthesia, yielding 885 mL of bloody fluid. Comprehensive work-up for infectious, rheumatologic, or oncologic etiologies was negative. The presumptive diagnosis was post-infectious pericarditis. Acute pericarditis is often associated with a concurrent or preceding viral illness and usually presents with chest pain.1, 2 Symptoms are generally more severe if pericardial fluid accumulates rapidly.2 Cardiac tamponade occurs when enough fluid accumulates to impair diastolic function. Beck's triad of hypotension, muffled heart sounds, and JVD is less common in children than adults.2 Although not evaluated in this case, a <50% decrease in the inferior vena cava diameter with deep inspiration, also known as “plethora,” is a highly sensitive (92%), but a nonspecific finding in cardiac tamponade.3 Indications for pericardiocentesis include hypotension, a suspected bacterial source, an immunocompromised host or it can be pursued for diagnostic purposes.2 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
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• W3206155983 date "2021-10-01" @default.
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• W3206155983 title "An adolescent male with subacute cough" @default.
• W3206155983 cites W1999106473 @default.
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• W3206155983 doi "https://doi.org/10.1002/emp2.12555" @default.
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