Tamponamento cardíaco na adolescência: dois casos clínicos

Abstract

Cardiac tamponade is a medical emergency and is the most serious complication of pericardial effusion. The authors describe two case reports with different etiologies, in adolescence. 17 years old female patient, goes to the emergency department due to polyarthralgia, chest pain, orthopnea and fatigue. At observation: fever, tachycardia, decreased cardiac sounds, decreased pulmonary sounds in bases and tibio-tarsal joint edema. Chest radiography: cardiomegaly and bilateral interstitial infiltrate; electrocardiogram: ST elevation; echocardiogram: massive pericardial effusion (“swinging heart”). Pericardiocentesis was performed, with no significant changes in the pericardial fluid. Therapy with non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA) and colchicine was started. Further investigation led to systemic lupus erythematosus (SLE) diagnosis and improvement happened after correct therapy. 16-year-old male patient with Crohns disease under azathioprine and adalimumab, goes to the emergency department due fever, cough and chest pain. Three days before he had started amoxicillin-clavulanic acid for pneumonia. At observation he was tachycardic, with decreased cardiac sounds, decreased right breath sounds and painful abdomen on palpation. Thoraco-abdominal ultrasound: pleural effusion, hepatomegaly, splenic nodules, adenopathies in the celiac trunk. 72 hours after admission, under triple antibiotical therapy, there was clinical worsening and a thoracoabdominal CT was performed: pericardial and pleural effusion, mediastinal adenomegalies, hepatosplenomegaly, splenic lesions. Echocardiogram: pericardial effusion with collapse of the right cavities. Pericardial fluid showed an adenosine deaminase (ADA) of 53U/L. Clinical improvement after therapy for tuberculosis was started. Clinical suspicion is essential for a rapid therapeutic intervention, with echocardiography being the gold standard.