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

Abstract

Purulent bacterial pericarditis is rare and associated with significant short- and long-term morbidity. We report a case of purulent bacterial pericarditis caused by Group A Streptococcus in an immunocompetent young child presenting with a pericardial mass. She was successfully treated with a combined medical and early surgical approach. (Level of Difficulty: Intermediate.).

Keywords: pediatric surgery; pericardial effusion; treatment.

Graphical abstract

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.

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.

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.

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.