Case Report
A 15-months old boy had presented with fever and respiratory distress of three days duration. At the time of admission, he had signs and symptoms of acute circulatory failure with tachypnea, tachycardia, and hypotension. He was febrile and irritable, and had no rash. Chest auscultation showed good bilateral air entry but muffled heart sounds. Abdominal examination was otherwise normal except for hepatomegaly.He had no significant history of illness prior to the current admission. He had normal growth and vaccinated as per recommended schedule. His CXR demonstrated significant cardiomegaly and a bedside 2D-ECHO (Fig.1) showed a massive pericardial effusion causing an impending tamponade, and a solid vascular mass in the left ventricle extending into the anterior as well as superior mediastinum. In view of hemodynamic instability, he underwent an immediate pericardiocentesis which drained around 200 ml of blood stained fluid. A smear study of the pericardial fluid showed benign reactive mesothelial cells, macrophages, neutrophils but had no evidence of malignancy. In light of 2D ECHO findings, it was decided to do a surgical evaluation of the cardiac mass.