Point of Care Ultrasound (POCUS) in pediatric cardiac masses : Case series of a novel trend

Abstract

Background : The utility of point-of-care ultrasound is well supported by many randomized controlled trials. Gradually pediatric emergency medicine providers and pediatricians are also embracing this technology in everyday practice. Recently American Academy of pediatrics concluded in its policy statement that evidence in support of point-of care ultrasonography as an adjunct to the clinical effectiveness of primary emergency medicine personnel including pediatricians and neonatologists is growing. It further recommended establishment of training, credentialing, and programs for point of care ultrasound to improve the care of pediatric patients. In Indian scenario there are no standard guidelines for the practice of point-of-care ultrasound by pediatricians. Results : Keeping this perspective in mind we present here a case series of five patients with cardiac masses which were detected during point of care ultrasound. First case was paraneonate who presented with pyrexia of unknown origin and refractory congestive cardiac failure .During POCUS left atrial mass was detected which was acting like mitral valve stenosis .Mass was removed surgically and was found to be myxoma . Second was known case of nephrotic syndrome presented with peritonitis and septic shock and right atrial thrombus was detected accidentally .He was started on low molecular weight heparin after stabilization and resolution of thrombus was seen on follow up. Third case was chronic renal disease on permanent dialysis with permacath in left internal jugular vein .He presented with flash pulmonary edema and right atrial mass at the tip of catheter .His blood culture grew citrobacter .He was treated for infective endocarditis but succumbed to his primary disease after 2 months. Fourth case was diagnosed case of ventricular septal defect at birth ,who presented to us with stroke and mitral valve vegetations were found during POCUS. His blood culture grew rapidly growing non-tuberculous mycobacteria .He died after 3 months of diagnosis.Fifth case was diagnosed case of acute myeloid leukemia with febrile neutropenia ,who had large right ventricular mass which was removed by open heart surgery and turned out to aspergilloma. He had stormy post operative course and died . Conclusion : Out of five patients,four patient had predisposing factors for either thrombus or infective endocarditis and three patient died during course of illness. In all these patients ,detection of cardiac mass by point of care ultrasonography accelerated the management.