Pediatric Infective Pericarditis Differential Diagnoses

  • Author: Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH; Chief Editor: Stuart Berger, MD   more...
 
Updated: Jul 15, 2011
 
 

Diagnostic Considerations

Indications for pericardial drainage include hemodynamic instability or diagnostic uncertainty for the etiology of the pericardial effusion. Early identification of bacterial effusion is important because it requires antibiotic therapy and pericardial drainage. Any underlying collagen-vascular disease must be recognized.

Diseases associated with pericardial effusion and tamponade include the following:

Go to Infective Endocarditis for complete information on this topic.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH,  Consulting Staff, Department of Child Health, University Hospital of North Tees and Hartlepool, UK

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH, is a member of the following medical societies: British Cardiac Society, Paediatrician with Cardiology Expertise Special Interest Group, Royal College of Paediatrics and Child Health, and Royal College of Physicians and Surgeons of Glasgow

Disclosure: Nothing to disclose.

Coauthor(s)

John Berger, MD  Associate Professor, Department of Pediatrics, George Washington University School of Medicine, Director, Cardiac Intensive Care and Pulmonary Hypertension Program, Children's National Medical Center

John Berger, MD is a member of the following medical societies: American Academy of Pediatrics and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Ira H Gessner, MD  Professor Emeritus, Pediatric Cardiology

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Hugh D Allen, MD  Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. Roubille F, Gahide G, Moore-Morris T, Granier M, Davy JM, Vernhet H, et al. Epstein Barr virus (EBV) and acute myopericarditis in an immunocompetent patient: first demonstrated case and discussion. Intern Med. 2008;47(7):627-9. [Medline].

  2. Wu CT, Huang JL. Pericarditis with massive pericardial effusion in a cytomegalovirus-infected infant. Acta Cardiol. Oct 2009;64(5):669-71. [Medline].

  3. Tapparel C, L'Huillier AG, Rougemont AL, Beghetti M, Barazzone-Argiroffo C, Kaiser L. Pneumonia and pericarditis in a child with HRV-C infection: a case report. J Clin Virol. Jun 2009;45(2):157-60. [Medline].

  4. Ratnapalan S, Brown K, Benson L. Children presenting with acute pericarditis to the emergency department. Pediatr Emerg Care. Jul 2011;27(7):581-5. [Medline].

  5. Masood SA, Kiel E, Akingbola O, Green R, Hodges L, Petterway G. Cardiac tamponade and pleural effusion complicating varicella: a case report. Pediatr Emerg Care. Nov 2008;24(11):777-81. [Medline].

  6. Ananthasubramaniam K, Farha A. Primary right atrial angiosarcoma mimicking acute pericarditis, pulmonary embolism, and tricuspid stenosis. Heart. May 1999;81(5):556-8. [Medline]. [Full Text].

  7. Habashy AG, Mittal A, Ravichandran N, Cherian G. The electrocardiogram in large pericardial effusion: the forgotten "P" wave and the influence of tamponade, size, etiology, and pericardial thickness on QRS voltage. Angiology. May-Jun 2004;55(3):303-7. [Medline].

  8. Imazio M, Bobbio M, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. Sep 27 2005;112(13):2012-6. [Medline].

  9. Levy PY, Fournier PE, Charrel R, Metras D, Habib G, Raoult D. Molecular analysis of pericardial fluid: a 7-year experience. Eur Heart J. Aug 2006;27(16):1942-6. [Medline].

  10. Adler Y, Finkelstein Y, Guindo J, et al. Colchicine treatment for recurrent pericarditis. A decade of experience. Circulation. Jun 2 1998;97(21):2183-5. [Medline]. [Full Text].

  11. Yazigi A, Abou-Charaf LC. Colchicine for recurrent pericarditis in children. Acta Paediatr. May 1998;87(5):603-4. [Medline].

 
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Two-dimensional echocardiograph shows a large pericardial effusion.
M-mode echocardiograph shows moderate pericardial effusion.
Plain chest radiograph in a 2-year-old boy with viral pericarditis and massive pericardial effusion.
Left: Chest radiograph in a patient with bacterial pericarditis revealing cardiomegaly and left lower lobe infiltrate with marked increase in pulmonary vascular markings. Right: The same patient after placement of a pigtail pericardial catheter and pulmonary artery catheter.
Apical 4-chamber view from a patient with bacterial pericarditis. The large pericardial effusion (EF) appears as an echo clear space in this view surrounding the right atrium (RA) and left ventricle (LV). The RA wall is collapsed indicating tamponade. The longer the duration of RA inversion into systole correlates with increasing hemodynamic severity.
A 15-lead ECG from a patient with bacterial pericarditis demonstrating marked ST elevation in multiple leads.
This ECG shows markedly decreased QRS voltage and electrical alternans (especially in lead V1)
 
 
 
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