A 14-Year-Old Boy with Unusual Presentation of Respiratory Distress

Adam W Powell,Samuel Hanke,James S Tweddell,Nicolas Madsen

doi:10.1155/2016/7313942

Adam W Powell, Samuel Hanke + Show 2 more

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https://doi.org/10.1155/2016/7313942

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Abstract

There are multiple cardiac etiologies for wheezing and respiratory distress which require a high degree of suspicion for the pediatrician to diagnose. We present a case of a patient with a history of long-standing mild persistent asthma with minimal improvement on controller and bronchodilator therapies who presented to the emergency room with acute respiratory distress. When he demonstrated a lack of improvement with traditional respiratory therapies, additional etiologies of respiratory distress were considered. Ultimately an echocardiogram was performed, which revealed the diagnosis of cor triatriatum. He underwent surgical resection of his accessory membrane and has had no additional symptoms of asthma since repair.

Highlights

Cor triatriatum is a rare congenital heart defect that can present with isolated respiratory distress mimicking other pulmonary conditions
While this is an uncommon diagnosis for the pediatrician to make in the patient with respiratory distress, it is a part of a larger differential diagnosis of cardiac lesions that may present with respiratory distress or recurrent, treatment refractory wheezing
A high index of suspicion is required to make the appropriate diagnosis in a patient with respiratory symptoms that do not respond as expected to usual interventions

Summary

Introduction

Cor triatriatum is a rare congenital heart defect that can present with isolated respiratory distress mimicking other pulmonary conditions. While this is an uncommon diagnosis for the pediatrician to make in the patient with respiratory distress, it is a part of a larger differential diagnosis of cardiac lesions that may present with respiratory distress or recurrent, treatment refractory wheezing. A high index of suspicion is required to make the appropriate diagnosis in a patient with respiratory symptoms that do not respond as expected to usual interventions. The treatment of choice is surgical resection of the accessory membrane that is generally well tolerated. Long-term follow-up with pediatric cardiology is required after resection to monitor for rare sequelae

Case Presentation

Findings

Discussion