Hemopericardium Following Norovirus Gastroenteritis in a Child: An Uncommon Presentation

Figures

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  Figure 1. Initial Investigations Panel A: Chest radiograph (posteroanterior (PA) view) demonstrating cardiomegaly with a cardiothoracic ratio of 0.58 (normal ≤0.55 for 20 months of age), consistent with pericardial effusion. Panel B : 12-lead ECG showing sinus tachycardia (~150 bpm) with low QRS voltage in the limb leads, consistent with pericardial effusion.

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  Figure 2. Echocardiography on admission Representative echocardiographic views demonstrating a large circumferential pericardial effusion (2.5 cm) with echogenic densities and tamponade physiology. Panel A: Parasternal short-axis. Panel B: Parasternal long-axis views, apical four-chamber view and M-mode. Panel C : Plethoric (dilated) IVC with reduced inspiratory collapse (<50%), indicating elevated right atrial pressure.

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  Figure 3. Chest CT Angiography Panels A and B : Coronal and axial CT views showing large circumferential pericardial effusion without vascular or structural abnormalities. Region of interest (ROI)-based attenuation measurements of pericardial effusion in all views revealed values between 39 and 62 HU, which confirm hemorrhagic fluid. One ROI (179 HU) was excluded as artifact.

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  Figure 4. Post-Pericardiocentesis and Follow-Up Echocardiography Panels A, B: Post-pericardiocentesis parasternal long-axis and apical four-chamber views showing resolution of effusion. Panels C, D: Six-week follow-up parasternal long-axis and short-axis views demonstrating absence of residual effusion.