‘Floating’ left atrial appendage in an infant with chylopericardium

We present an interesting image of a ‘floating left atrial (LA) appendage’ in a 5-month-old female infant with pericardial tamponade. Clinical features of respiratory distress, lethargy and difficulty in suckling were present and the jugular venous pressure (JVP) was raised, although the wave forms were not easily assessable due to the child being in respiratory distress and uncooperative. The echocardiographic evaluation revealed the signs of tamponade along with another interesting finding that the left atrial appendage (LAA) was elongated and membrane like and was freely moving and ballooning with atrial contraction in the pericardial fluid around it as though ‘floating’. Cath tracings were not performed as the first priority was an emergency lifesaving pericardiocentesis. There was another abnormal bulge posterolaterally. The other cardiac chambers were normal and there was no obvious echocardiographic evidence of any pressure overload of LA in the form of LA dilation(figures 1 and 2; see videos 1–4).