Abstract Ref Number = APCP762
CADIAC TAMPONADE DUE TO MASSIVE PERICARDIAL EFFUSION DUE TO TUBERCULOUS PERICARDITIS IN A GIRL WITH EBSTEINâ€™S ANOMALY
Ade Malikul Alim,St Aizah Lawang,Besse Sarmila
Departemen Ilmu Kesehatan Anak FK UNHAS
Background : Cardiac tamponade is a life threatening condition, started as a pericardial effusion caused by fluid accumulation in the pericardial space that compresses the cardiac chambers and restricts them from normal filling, with incidence of 2:10.000. Mostly caused by direct trauma to the chest, malignancy and tuberculosis. Tuberculous pericarditis accounted for 0.5-4% of all child tuberculosis and associated with 90% of child pericardial effusion. Ebstein’s anomaly is a congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle, accounted for <1% of all congenital heart defects presenting in 1 per 200,000 live births.
Case Presentation Summary : A 13 years-old girl admitted to WS Hospital with breathing difficulties, occurred since 1 week before admitted and worsened by activities. There were cough and fever since more than 2 weeks before admitted. Decreased body weight in the last month. There was history of contact with an adult who underwent tuberculosis treatment. There was subcostal and intercostal chest indrawing, enlarged heart borders, diminished heart sounds, pericardial friction rub sound, and systolic murmur. There was liver enlargement. Tubercolous score was 6. Chest X-ray showed cardiomegaly with signs of pericardial effusion and suspected bilateral pleural effusion. Electrocardiography showed low voltage, pulsus alternans, right axis deviation. Echocardiography showed massive pericardial effusion with signs of cardiac tamponade, Ebstein’s anomaly, and mild-moderate tricuspid regurgitation. After given diuretik, digoxin, antibiotics, anti tuberculous drugs and corticosteroid, pericardiosentesis with + 2000 ml removed, her condition improved and she was sent home. The pericardial fluid culture and acid staining results was negative.
Learning Points/Discussion : • Cardiac tamponade and pericardial effusion are uncommon child emergencies. • Early recognition and intervention can save the child. • Tuberculous pericarditis was the main cause of the pericardial effusion. • Ebstein anomaly are rare congenital heart disease that doesn’t show any symptoms until adolescence or adulthood.
Keywords: Cardiac Tamponade Massive Pericardial Effusion Tuberculous Pericarditis Ebstein's Anomaly