Abstract
BackgroundThe diagnosis of pericardial effusion with cardiac tamponade can at times be elusive in pediatric patients since it is relatively uncommon. Point-of-care ultrasound (POCUS) can readily be performed at the bedside to assess for the presence of a pericardial effusion, tamponade, and can occasionally yield unexpected results.Case presentationTwo cases where POCUS unexpectedly identified pericardial effusions, with one patient who also had an anterior mediastinal mass.ConclusionsThough underutilized, cardiac POCUS in children can be immediately life-saving and drastically change the clinical management at the patient’s bedside.
Highlights
The diagnosis of pericardial effusion with cardiac tamponade can at times be elusive in pediatric patients since it is relatively uncommon
There remains a tremendous potential to study the utilization of cardiac Point-of-care ultrasound (POCUS) in pediatric patients in the acute care setting
Cardiac POCUS may be a useful adjunct to the clinical examination when radiologic and laboratory studies can be unreliable, non-specific, and not always timely
Summary
There remains a tremendous potential to study the utilization of cardiac POCUS in pediatric patients in the acute care setting. The use of focused cardiac POCUS for suspected pericardial effusions, tamponade, and mediastinal masses presents an opportunity for pediatric emergency medicine, cardiology, and critical care services to collaborate and establish best practices for these, at times, elusive diagnoses. The focused cardiac POCUS showed a large mediastinal mass with a circumferential pericardial effusion, diastolic right ventricle collapse and a small left pleural effusion (Fig. 3). These findings were consistent with sonographic tamponade, which was unexpected, given that the patient did not yet exhibit clinical tamponade (BP and HR were noted to be within normal limits for age). Due to the POCUS findings, computerized tomography (CT) of the chest was postponed due to the risk of Abbreviations Ao: aortic outflow tract; BP: blood pressure; CXR: chest X-ray, radiograph; CT: computerized tomography; EKG: electrocardiogram; HR: heart rate; IVC: inferior vena cava; LA: left atrium; LV: left ventricle; PEM: pediatric emergency medicine; PICU: pediatric intensive care unit; POCUS: point-of-care ultrasound; RR: respiratory rate; RV: right ventricle; US: ultrasound
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