Case:
A 10 week old previously healthy female infant born via spontaneous
vaginal delivery (SVD) at full term gestation, who was doing well until
2 months at which time she developed signs and symptoms of URI followed
by cough but no fever. While in the medical office the patient went limp
after a nasopharyngeal swab test and subsequent cardiopulmonary
resuscitation (CPR) was done with return to spontaneous circulation
(ROSC) after 2 minutes.
She was transferred to a local Emergency Department where she was
intubated with a 3.5 uncuffed tube for concern of severe acidosis and
work of breathing. A bedside ECHO showed a large circumferential
pericardial effusion (Figure 1) . The infant was transferred to
Loma Linda University Children’s Hospital (LLUCH) for higher level of
care.
At LLUCH a pericardiocentesis was done and a pigtail was sutured into
position and placed on low intermittent suction. A CT Chest with
contrast showed a 4.2 x 3.6 x 3.8 cm right sided pericardial/mediastinal
hypodense mass with internal calcifications. The heart was shifted to
the left due to mass effect. The mass was partially surrounding the
aorta and SVC as well as the right pulmonary artery.
Echocardiogram showed normal biventricular systolic function with and EF
of approximately 67% with no evidence of flow obstruction. A patent
foramen ovale with a small shunt was also found. It also showed a
multi-cystic mass appearing on top of the right atrium (Figure
2).
The mediastinal teratoma was excised via sternotomy and pericardiectomy