Pericardial Effusion with Bilateral Pleural Effusion and Bronchiectasis

 
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A 14 month old girl presented with fever and cough since 15 days and breathlessness since 3 days. She had measles followed by pneumonia at 9 months of age following which patient has had increased respiratory rate. On examination, she had heart rate of 120 per min and respiratory rate of 30 per min without distress. She was malnourished {weight = 6.2 kg, height = 69 cm}. Her anterior fontanelle was open and BCG scar was absent. On systemic examination she had decreased air entry on left side with bilateral coarse crepitations and hepatomegaly. Her investigations showed anemia {hemoglobin = 8.1 gm percent}, leucocytosis {WBC count = 28,500 per cumm} with polymorphic predominance} and platelet count of 6, 23,000 per cumm. X-Ray Chest showed left sided white lung. HRCT of chest showed pericardial effusion with left sided collapse of lung with bronchiectatic changes and bilateral pleural effusion with right sided air trapping and perihilar lymphadenopathy. Echocardiography confirmed pericardial effusion 1.6 cm posteriorly with internal echoes and fibrinous strands without cardiac dysfunction. USG Abdomen showed mild hepatomegaly. HIV ELISA and Mantoux test was negative. The child was treated with 4 drugs antituberculous therapy {ATT}. A repeat echocardiography showed organized minimal collection in the pericardial cavity of 0.5 cm thickness. The child is now asymptomatic.
Expert Opinion :
Since this child clinically responded to ATT and pericardial effusion also decreased, we did not investigate further from lymphoma point of view. If it was lymphoma, the child should have deteriorated. We did add steroids to prevent constrictive pericarditis.
Answer Discussion :
D
DINESH K TIWA
bubble
yes but this looks tubercular
7 years ago
M
Mamatha Prabhuvaiah
bubble
this is a case of TB aggravated by measles. steroids have to be given for any serous TB.
7 years ago

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EAP 2017
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