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.