T-cell lymphoma and pigtail catheter drainage of a massive paraneoplastic pleuro-pericardial effusion in a child

An 9-year-old black African boy was admitted for tachypnoea. His medical history was free of event. Clinical examination revealed abolition of vesicular murmure in the right lung, tachycardia, and mild jugular venous distension. Chest X-ray showed complete opacification of the right hemithorax due to massive pleural effusion. Pigtail catheter drainage yielded 4500 mL of an exudative fluid. A second chest X-ray performed after the drainage revealed an enlarged cardiac silhouette associated with a voluminous mass (Panel A). The mass was located in the anterior mediastinum on computed tomography scan (Panel B). A few hours later, the patient developed hypotension with pulsus paradoxus indicative of cardiac tamponade. Transthoracic echocardiography showed large pericardial effusion with diastolic collapse of the right atrial and ventricular free walls (Panel C). Doppler examination found exaggerated respiratory variations in transvalvular flows. Management consisted in volume expansion and a sub-xyphoid echocardiography-guided percutaneous pericardial puncture, with insertion of a pigtail catheter, allowing aspiration of 150 mL of pericardial fluid and immediate haemodynamic improvement. Cytological analysis of both pleural and pericardial fluids led to diagnosis of T-cell lymphoma in Papanicolaou staining (Panel D). Corticosteroid and chemotherapy were initiated. After a 3 months follow-up, he is doing well.