Surgical and Medical Management of Purulent Bacterial Pericarditis With Pericardial Mass in a Young Child

Figures

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  Figure 1. CXR Imaging at Presentation and on Hospital Day 3 (A) CXR on the day of presentation. No pleural effusions, no cardiomegaly. (B) CXR on hospital day 3. Bilateral pleural effusions and cardiomegaly noted. CXR = chest x-ray.

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  Figure 2. Initial TTE Imaging TTE from hospital day 3, before any intervention. (A) Apical 4-chamber view shows a large circumferential pericardial effusion and a large pericardial mass (phlegmon) lateral and posterior to left ventricle (measuring 5.2 cm × 1.8 cm), extending from the region of the AV groove to the apex and appeared to be attached to the epi-pericardium by multiple fibrin strands. (B) Parasternal short-axis view demonstrating the large circumferential pericardial effusion and phlegmon. AV = atrioventricular; TTE = transthoracic echocardiography.

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  Figure 3. TTE Imaging After Pericardiocentesis TTE performed after pericardiocentesis with (A) apical 4-chamber, (B) parasternal short-axis, and (C) parasternal long-axis views showing reaccumulation of pericardial effusion and largely unchanged appearance and size of the pericardial mass. Abbreviation as in Figure 2.

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  Figure 4. Gross Specimen and Histopathologic Findings Indicating Phlegmon (A) Pericardial mass, gross specimen after surgical resection. (B) Histopathology of pericardial mass with a neutrophilic inflammatory infiltrate, fibrin deposition, extravasated red blood cells, granulation tissue, and early fibrosis. Formalin-fixed paraffin-embedded tissue slide stained with hematoxylin and eosin.