Absceso en miocardio secundario a neumonía adquirida en la comunidad por Pseudomona aeruginosa en lactante inmunocompetente: reporte de caso / Myocardial abscess secondary to community acquired Pseudomona aeruginosa pneumonia in an immunocompetent infant: case report

La Pseudomona aeruginosa es una causa importante de infecciones asociadas a la atención de la salud y en las neumonías adquiridas en la comunidad, rara vez se identifica como el agente patógeno, siendo estas de progresión rápida y de mal pronóstico. Se trata de un menor de un año de edad inmunocompetente el cual fallece en casa una semana después de una lesión en la planta del pie derecho que según familiares le sacaron "pus", tratado con antinflamatorios y analgésicos. Se le realizó necropsia que evidenció cicatriz en planta de pie derecho sin lesiones traumáticas. Pulmones de consistencia indurada, con adherencias y áreas que impresionan necróticas, asociada a efusión pleural. El estudio histológico reportó un proceso infeccioso pulmonar agudo abscedado que se diseminó por continuidad a tejido cardiaco y en estudios microbiológicos de pulmón y bazo se reportó Pseudomona aeruginosa.

Pseudomona aeruginosa is an important cause of health care-associated infections and in community-acquired pneumonias, it is rarely identified as the pathogenic agent, being of rapid progression and poor prognosis. This is a one-year-old immunocompetent minor who died at home one week after a lesion in the sole of the right foot which, according to family members, caused "pus", treated with anti-inflammatory and analgesic drugs. A necropsy was performed, which showed a scar on the sole of the right foot with no traumatic lesions. Lungs of indurated consistency, with adhesions and areas that appear necrotic, associated with pleural effusion. The histological study reported an abscessed acute pulmonary infectious process that spread by continuity to cardiac tissue and microbiological studies of lung and spleen reported Pseudomona aeruginosa.

Signo de Spodick: ¿aliado o enemigo? / Spodick's sign: ally or enemy?

La pericarditis se refiere a la inflamación de las capas del pericardio y es la forma más común de enfermedad pericárdica. Puede estar asociada a derrame pericárdico y resultar en un taponamiento. La enfermedad puede ser una condición aislada o una manifestación cardíaca de un trastorno sistémico (por ejemplo, enfermedades autoinmunes o autoinflamatorias). La pericarditis se categoriza como aguda, incesante, recurrente o crónica, pero se debe tener en cuenta que también se clasifica como de etiología infecciosa y no infecciosa, siendo la presentación idiopática la más común

Pericarditis refers to inflammation of the layers of the pericardium and is the most common form of pericardial disease. It may be associated with pericardial effusion and result in tamponade. The disease may be an isolated condition or a cardiac manifestation of a systemic disorder (e.g., autoimmune or autoinflammatory diseases). Pericarditis is categorized as acute, incessant, recurrent, or chronic, but it should be noted that it is also classified as being of infectious and noninfectious etiology, with the idiopathic presentation being the most common

Utilidad de la tomografía computarizada multicorte para la estimación de la composición del derrame pericárdico / Usefulness of computed tomography densities to estimate the composition of pericardial effusion

Resumen El derrame pericárdico (DP) es una entidad frecuente en la práctica diaria, que puede ocurrir por un amplio rango de patologías. Los métodos por imágenes constituyen una herramienta diagnóstica clave en la evaluación del pericardio. El ecocardiograma transtorácico (ETT) se considera de primera línea por su costo-efectividad. La tomografía computarizada multicorte (TCMC), por su parte, representa un valioso complemento ante limitaciones del ETT y en la evaluación de urgencia del paciente con sospecha de DP. El objetivo del trabajo es mostrar la utilidad y rol de la TCMC, mediante la medición de densidades, para estimar la etiología del DP, ilustrado con casos de nuestra institución.

Abstract Pericardial effusion (PE) is a common entity in daily practice, which can occur due to a wide range of conditions. Imaging methods are a key diagnostic tool in the evaluation of the pericardium. Transthoracic echocardiogram (TTE) is the first line imaging method because of its cost-effectiveness. Multi-slice Computed Tomography (MSCT), on the other hand, represents a valuable complement to the limitations of TTE and in emergency evaluation of the patient with suspected PE. The objective of this review is to show the usefulness and role of the MSCT —through the measurement of densities— to estimate the etiology of PE, illustrated with cases of our Institution.

Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era

Abstract Background: Pericardial effusion is a relatively common finding and can progress to cardiac tamponade; etiological diagnosis is important for guiding treatment decisions. With advances in medicine and improvement in the social context, the most frequent etiological causes have changed. Objectives: To evaluate the clinical and laboratory characteristics, etiology, and clinical course of patients with pericardial effusion and cardiac tamponade. Materials and methods: Patients with pericardial effusion classified as small (< 10 mm), moderate (between 10-20 mm), or severe (> 20 mm) were included. Data from the clinical history, physical examination, laboratory tests, and complementary tests were evaluated in patients with pericardial effusion and cardiac tamponade. The significance level was set at 5%. Results: A total of 254 patients with a mean age of 53.09 ± 17.9 years were evaluated, 51.2% of whom were female. A total of 40.4% had significant pericardial effusion (> 20 mm). Pericardial tamponade occurred in 44.1% of patients. Among pericardial effusion patients without tamponade, the most frequent etiologies were: idiopathic (44.4%) and postsurgical (17.6%), while among those with tamponade, the most frequent etiologies were postsurgical (21.4%) and postprocedural (19.6%). The mean follow-up time was 2.2 years. Mortality was 42% and 23.2 in those with and without tamponade, respectively (p=0.001). Conclusions: There is an etiological difference between pericardial effusion patients with and without cardiac tamponade. An idiopathic etiology is more common among those without tamponade, while postinterventional/postsurgical is more common among those with tamponade. The tamponade group had a higher mortality rate.

Predictive factors of recurrence after pediatric acute pericarditis

Abstract Objective The predisposing factors for pericarditis recurrence in the pediatric population have not yet been established. This study aimed to define the risk factors for the unfavorable prognosis of pediatric acute pericarditis. Methods This was a retrospective study that included all patients with acute pericarditis treated from 2011 to 2019 at a tertiary referent pediatric center. Results The study included 72 children. Recurrence was observed in 22.2% patients. Independent risk factors for recurrence were: erythrocyte sedimentation rate ≥ 50 mm/h (p = 0.003, OR 186.3), absence of myocarditis (p = 0.05, OR 15.2), C-reactive protein ≥ 125 mg/L (p = 0.04, OR 1.5), and non-idiopathic etiology pericarditis (p = 0.003, OR 1.3). Corticosteroid treatment in acute pericarditis was associated with a higher recurrence rate than treatment with non-steroid anti-inflammatory therapy (p = 0.04). Furthermore, patients treated with colchicine in the primary recurrence had lower recurrence rate and median number of repeated infections than those treated without colchicine (p = 0.04; p = 0.007, respectively). Conclusion Independent risk factors for recurrence are absence of myocarditis, non-idiopathic etiology pericarditis, C-reactive protein ≥ 125 mg/L, and erythrocyte sedimentation rate ≥ 50 mm/h. Acute pericarditis should be treated with non-steroid anti-inflammatory therapy. A combination of colchicine and non-steroid anti-inflammatory drugs could be recommended as the treatment of choice in recurrent pericarditis.

Miopericarditis aguda versus síndrome coronario agudo: reporte de un caso / Acute myopericarditis versus acute coronary syndrome: case report / Miopericardite aguda versus síndrome coronariana aguda: relato de um caso

La miopericarditis aguda es una pericarditis aguda con compromiso miocárdico menor. En las primeras horas de evolución el cuadro clínico puede confundirse con un síndrome coronario agudo, en especial cuando el electrocardiograma presenta elevación del segmento ST y marcadores de necrosis miocárdica elevados. La resonancia magnética cardíaca tiene un papel importante para diferenciar las dos enfermedades. Presentamos el caso de un hombre de 36 años de edad ingresado por dolor de pecho, elevación del segmento ST y de marcadores de necrosis miocárdica. Se realiza angiografía coronaria, que no evidencia lesiones angiográficamente significativas, resonancia magnética cardíaca con contraste de gadolinio, en la que se observa leve derrame pericárdico, presencia de edema y realce tardío con patrón parcheado subepicárdico e intramiocárdico en pared lateral. Los hallazgos del estudio confirman el diagnóstico de miopericarditis.

Acute myopericarditis is an acute pericarditis with minor myocardial compromise. During the first hours from onset the clinical presentation can be confused with an acute coronary syndrome, especially when the electrocardiogram presents with ST segment elevation and increased markers of myocardial necrosis. Cardiac magnetic resonance imaging plays an important role to differentiate between these two diseases. We present the case of a 36-year-old male who was admitted with chest pain, ST segment elevation and increased markers of myocardial necrosis. Coronary angiography is performed reporting no significant angiographic findings. Cardiac magnetic resonance imaging with contrast medium (gadolinium) is performed, reporting mild pericardial effusion, presence of edema, and delayed uptake with a subepicardial and intramyocardial patchy pattern on the lateral wall. These test findings confirm the diagnosis of myopericarditis.

A miopericardite aguda é uma pericardite aguda com pequena deterioração miocárdica. Nas primeiras horas de evolução do quadro clínico podem ser confundidas com síndrome coronariana aguda, principalmente quando o eletrocardiograma mostra supradesnivelamento do segmento ST e marcadores elevados de necrose miocárdica. A ressonância magnética cardíaca desempenha um papel importante em distinguir as duas doenças. Apresentamos o caso de um homem de 36 anos admitido por dor torácica, supradesnivelamento do segmento ST e elevação dos marcadores de necrose miocárdica, foi realizada cineangiocoronariografia, onde não foram evidenciadas lesões angiograficamente significativas. Foi realizada a ressonância magnética cardíaca com contraste de gadolínio e foram observados derrame pericárdico leve, edema e realce tardio com um padrão irregular subepicárdico e intramiocárdico na face lateral. Os resultados do estudo confirmam o diagnóstico de miopericardite.

Síndrome de Brugada asociado a pericarditis aguda / Brugada syndrome associated to acute pericarditis

Resumen Comunicamos el caso de un hombre de 56 años que ingresó por pericarditis aguda febril, probablemente de causa viral, que durante su evolución presentó una fibrilación auricular paroxística y taquicardia ventricular polimorfa recurrente. El análisis de la historia clínica y serie electrocardiográfica permitió el diagnóstico retrospectivo asociado de un síndrome de Brugada. Hubo buena respuesta inicial al tratamiento antiinflamatorio asociado a colchicina y se implantó un desfibrilador automático intracavitario para prevención de muerte súbita. Se discuten aspectos clínicos del síndrome de Brugada, la importancia de la fiebre y de la pericarditis como cuadro clínico asociado.

Abstract A 56-year-old patient was admitted for acute febrile pericarditis, probably viral, who presented with paroxysmal atrial fibrillation and recurrent polymorphic ventricular tachycardia during his clinical course. Analysis of the clinical and electrocardiographic findings allowed the retrospective diagnosis of Brugada syndrome in the context of pericarditis. An initial response to anti-inflammatory treatment associated with colchicine was good. An internal cardioverter defibrillator was implanted to prevent sudden death. Clinical aspects of the Brugada syndrome, the importance of fever and pericarditis as an associated clinical condition are discussed.

Tratamiento quirúrgico de la pericarditis purulenta: reporte de un caso / Surgical treatment of purulent pericarditis: report of a case

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.

Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.

Hypertrophic cardiomyopathy masked by pericarditis

Hypertrophic cardiomyopathy used to be regarded as a rare untreatable cause of sudden death in young male athletes. This report is the case of a middle-aged female patient with hereditary hypertrophic cardiomyopathy masked by superimposed pericarditis and revealed by autopsy. This case report illustrates how co-morbidity can hide a crucial diagnosis. This case report also illustrates the value of autopsy disclosing a familial disease that is increasingly recognized and dramatically more treatable than a few decades ago. Sudden death due to hypertrophic cardiomyopathy has become preventable, if the diagnosis is made soon enough. The lessons for patient care from this case include the importance of not missing the diagnosis of hypertrophic cardiomyopathy in female patients.

Treatment of pericardial effusion through subxiphoid tube pericardiostomy and computerized tomography- or echocardiography - guided percutaneous catheter drainage methods

Abstract Objective: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. Methods: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. Results: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. Conclusion: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Diagnóstico diferencial de pericardite aguda no infarto agudo do miocárdio com supradesnivelamento de segmento ST: relato de caso / Differential diagnosis of acute pericarditis in ST-segment elevation acute myocardial infarction: case report

A pericardite é um processo inflamatório do pericárdio de múltiplas causas, sendo a infecção viral a mais comum. O infarto agudo do miocárdio é um dos principais diagnósticos diferenciais. O objetivo deste artigo foi relatar um caso de pericardite aguda com supradesnivelamento de segmento ST. Os dados foram coletados em um hospital de ensino do Estado de Minas Gerais. O paciente era do sexo masculino, tinha 24 anos e era negro. Foi encaminhado ao serviço médico terciário devido à hipótese de síndrome coronariana aguda com supradesnivelamento do segmento ST. Nos exames do serviço médico de origem, apresentava supradesnivelamento do segmento ST de caráter difuso simultaneamente em paredes inferior e anterior, e alteração da isoenzima MB da creatina quinase de 100ng/mL e troponina I de 21ng/mL. No momento da admissão, encontrava-se em bom estado geral, afebril, estável hemodinamicamente e sem queixa de dor. Referiu que 4 dias antes da admissão, apresentou febre, mal-estar geral, odinofagia e tratamento de amigdalite. Os exames da admissão demonstravam ritmo sinusal, frequência cardíaca de 75bpm, supradesnivelamento de ST em D2, D3, aVF, V1 a V6, isoenzima MB da creatina quinase de 152ng/mL, troponina I de 1,28ng/mL, hemograma normal; ecocardiograma mostrou pericárdio de aspecto anatômico normal e fração de ejeção de 64%. O diagnóstico foi de pericardite aguda de provável etiologia infecciosa. O tratamento foi realizado com ibuprofeno por 7 dias e colchicina por 3 meses. Paciente evoluiu com alta hospitalar após 5 dias. O diagnóstico correto proporcionou a condução adequada do caso, permitindo a redução dos custos hospitalares e eliminando riscos de procedimentos desnecessários. (AU)

Pericarditis is an inflammatory process of the pericardium of multiple causes, being the most common viral infection. Acute myocardial infarction is one of the main differential diagnoses. The objective of this article was to report a case of acute pericarditis with ST-segment elevation. Data were collected at a teaching hospital in the state of Minas Gerais. The patient was a man of 24 years, black. He was referred to the tertiary medical service due to the hypothesis of Acute Coronary Syndrome with ST-segment elevation. In the tests from the medical service of origin, there was diffuse ST-segment elevation, simultaneously on lower and anterior walls, and a change in the Creatinine Kinase MB Isoenzyme of 100ng/ml, and troponin I of 21ng/ml. At the time of admission, he was in good general condition, afebrile, hemodynamically stable, with no complaint of pain. He said that 4 days before admission he had fever, malaise, odynophagia, and treatment for tonsillitis. The admission tests showed sinus rhythm, heart rate of 75bpm, ST-elevation in D2, D3, aVF, V1 to V6, MB isoenzyme of creatine kinase of 152ng/ml, troponin I of 1.28ng/ml, normal complete blood count; echocardiogram showed pericardium of normal anatomical aspect and ejection fraction of 64%. The diagnosis was acute pericarditis of probable infectious etiology. Treatment was performed with ibuprofen for seven days, and colchicine for three months. The patient was discharged from hospital after 5 days. The correct diagnosis provided adequate case management, allowing for reduced hospital costs, and eliminating risks of unnecessary procedures. (AU)

Associação de meningite e pericardite na doença pneumocócica invasiva: um caso raro / Association of meningitis and pericarditis in invasive pneumococcal disease: a rare case

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.

ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.

Caso de autopsia: Paracoccidioides diseminada en paciente inmunocomprometido / Autopsy Case: Disseminated paracoccidiodes in an immunocompromised patient

Paracoccidioides brasiliensis is the predominant dimorphic fungal disease in Latin America. Males between 29 to 40 years of age are most often affected. Inhalation of the infecting particle produces a localized alveolitis. The organisms then may disseminate to the skin, mucous membranes, lymph nodes, adrenal glands, liver, spleen, bones, central nervous system and digestive tract, giving a multisystemic affectation, mainly in immunocompromised hosts. A male 34 years old with a history of immunocompromised VIH +, was studied. The characteristics in authopsy are described, with previous diagnosis of diseminated. Paracoccidioides brasiliensis, with intraalveolar hemorrhage, pleuritis and pericarditis. Deep systemic micosis and opportunistic are pathologies that present with increased frequency in recent years, mainly by the rise of the VIH+ infected population. Despite this circumstance, the coexistence of Paracoccidioide infection and VIH+ is scarce in the literature, and for that reason, we present this case of autopsy.

Purulent pericarditis as a complication of pneumonia in an infant. clinical case report

ABSTRACT Introduction: Purulent pericarditis is an inflammatory process in the pericardium caused by bacterial infection. If experienced during childhood and with untimely diagnosis, it has a high mortality rate. Case presentation: A 10-month-old infant was admitted to a high complexity pediatric hospital in the city of Bogotá D.C, Colombia, due to clinical symptoms including cough, respiratory distress and fever. A chest x-ray was taken showing cardiomegaly and multilobar pulmonary involvement. The echocardiogram showed global pericardial effusion managed with pericardiotomy, in which 50 mL of turbid fluid with whitish membranes was obtained. Cytochemical test revealed 2 600 mm3 leukocytes with 90% PMN and protein elevation. Purulent pericarditis was diagnosed based on imaging and laboratory findings. Treatment was initiated with ceftriaxone and clindamycin for four weeks, obtaining effective clinical and echocardiographic resolution. Discussion: The clinical presentation and imaging, paraclinical and electrocardiographic findings suggested purulent pericarditis as the first possibility. This diagnosis was confirmed considering the characteristics of the pericardial fluid, which was compatible with an exudate. Clinical resolution supported by antibiotic management corroborated the diagnosis, even though microbiological isolation was not obtained in cultures. Conclusion: Purulent pericarditis is a rare disease in pediatrics and has a high mortality rate. Making a timely diagnosis and administering early treatment are related to a better prognosis of this pathology.

RESUMEN Introducción. La pericarditis purulenta es un proceso inflamatorio del pericardio producto de una infección bacteriana. De no lograrse un diagnóstico oportuno, se convierte en una patología con alta mortalidad en la infancia. Presentación del caso. Lactante de 10 meses de edad que ingresó a un hospital pediátrico de alta complejidad en Bogotá D.C., Colombia, por un cuadro clínico dado por tos, dificultad respiratoria y fiebre. Se tomó una radiografía de tórax donde se observó cardiomegalia y compromiso neumónico multilobar. El ecocardiograma mostró un derrame pericárdico global que requirió pericardiotomía, en la cual se obtuvo 50 mL de líquido turbio con membranas blanquecinas. En la prueba citoquímica se encontraron 2 600mm3 leucocitos, polimorfonucleares del 90% y elevación de proteínas. Con los hallazgos de imagenología y laboratorio se hizo el diagnóstico de pericarditis purulenta, por lo que se inició tratamiento con ceftriaxona y clindamicina por 4 semanas, obteniendo una resolución clínica y ecocardiográfica efectiva. Discusión. La presentación clínica y los hallazgos imagenológicos, paraclínicos y electrocardiográficos sugirieron como primera posibilidad pericarditis purulenta, lo cual se confirmó por las características de líquido pericárdico, que era compatible con un exudado. La resolución clínica, apoyada por el manejo antibiótico y a pesar de no obtener aislamiento microbiológico en los cultivos, corroboró el diagnóstico. Conclusiones. La pericarditis purulenta es una enfermedad poco frecuente en pediatría pero con alta mortalidad. Realizar un diagnóstico oportuno sumado a un tratamiento tempano se relaciona con un mejor pronóstico de esta patología.

Manejo de derrame pericárdico: revisión sistemática de la literatura / Management of pericardial effusion: systematic review of literature

Resumen Objetivo: Revisar sistemáticamente la efectividad del tratamiento no quirúrgico para el manejo del derrame pericárdico moderado o severo. Metodología: Se realizó una búsqueda sistemática desde febrero hasta junio de 2016 en las bases de datos Pub Med, SciELO y Lilacs, en inglés y español. Los términos de búsqueda utilizados fueron: Pericardial Effusion and Acute Pericarditis, Treatment, Therapy, Therapeutics, Management. Se eligieron artículos publicados entre 2011 y 2016 que abordaran el tratamiento del derrame pericárdico no quirúrgico y la pericarditis aguda. Se excluyeron artículos que evaluaran el manejo de taponamiento cardíaco, pericarditis constrictiva y derrame pericárdico por lesión miocárdica. La selección de artículos estuvo a cargo de dos evaluadores y, en caso de discrepancias, se consultó un tercer evaluador. Resultados: Se identificaron un total de 2.998 referencias; posteriormente, se seleccionaron 138 artículos, de los cuales se evaluaron sus resúmenes. Se eligieron dos artículos para la lectura a texto completo, y se aplicaron a estos las guías Strobe, para estudios observacionales, y Consort, para ensayos clínicos aleatorizados. Se evidenció que la pericarditis recurrente ocurrió en 26 de los 120 pacientes en el grupo de colchicina y en 51 de 120 en el grupo placebo, RRR: 0, 49 (IC = 0, 24-0, 65; p = 0, 0009). Conclusiones: la colchicina asociada a antiinflamatorios no esteroides evidenció ser efectiva en la pericarditis aguda idiopática y asimismo en sus recurrencias. Sin embargo, aún es necesario consultar más ensayos clínicos con mayor tamaño de muestra para determinar con exactitud la efectividad del tratamiento.

Abstract Objective: To present a systematic review of the effectiveness of non-surgical treatment for the management of moderate or severe pericardial effusion. Methodology: A systematic search was made from February to June 2016 in the databases of Pub Med, SciELO, and Lilacs, in English and Spanish. The search terms used were: Pericardial Effusion and Acute Pericarditis, Treatment, Therapy, Therapeutics, Management. Articles published between 2011 and 2016 that approached the non-surgical treatment of pericardial effusion and acute pericarditis were chosen. Articles that were excluded were those that evaluated cardiac tamponade, constrictive pericarditis, and pericardial effusion due to a myocardial lesion. The selection of the articles was the responsibility of two evaluators and, in case of discrepancies, a third evaluator was consulted. Result: A total of 2,998 references where identified, from which 138 articles were later selected, and their Abstracts were evaluated. Two articles were chosen in order to read the full text, and the Strobe guidelines for observational studies and the Consort guidelines for randomised clinical trials were used. It was shown that recurrent pericarditis occurred in 26 of the 120 patients in the colchicine group, and in 51 of 120 in the placebo group, with a relative risk ratio (RRR): 0.49 (95% CI; 0.24- 0.65; P=.0009). Conclusions: Colchicine combined with non-steroidal anti-inflammatory drugs showed to be effective in acute idiopathic pericarditis, as well as in their recurrences. However, more clinical trials with a larger sample size need to be consulted in order to determine the effectiveness of the treatment with more accuracy.

Derrame pericárdico y taponamiento cardiaco / Pericardial effusion and cardiac tamponade

Resumen El derrame pericárdico es la acumulación de más de 50 ml de líquido en el espacio pericárdico. La etiología es muy diversa ya que puede ser de causa idiopática o deberse a enfermedades primarias del pericardio, como las pericarditis de cualquier etiología, o por enfermedades sistémicas como el infarto agudo de miocardio y la rotura cardiaca contenida; o por cirugía cardiaca, hemorragia intrapericárdica, enfermedades metabólicas, transudación serosa (anasarca) y quilopericardio, entre otras. El estudio diagnóstico del derrame pericárdico siempre debe guiarse por la epidemiología local y requiere alta sospecha clínica. Cuando el derrame pericárdico se complica con taponamiento cardiaco, constituye una emergencia médica que requiere identificación e intervención inmediatas. Se exponen cuatro casos de pacientes con derrame pericárdico asociado a tuberculosis, mixedema, uremia y lupus, quienes desarrollaron taponamiento cardiaco.

Abstract Pericardial effusion is defined as the accumulation of more than 50 ml of fluid in the pericardiac space. Its origin is very diverse since it can be an idiopathic cause or be due to primary diseases of the pericardium, such as pericarditis of any origin. It can also be due to systemic diseases, such as acute myocardial infarction and contained cardiac rupture, as well as due to heart surgery, intra-pericardiac haemorrhage, metabolic diseases, serous transudation (anasarca), and chylopericardium, among others. The diagnostic work-up of pericardial effusion must always be guided by the local epidemiology, and requires a high clinical suspicion. When the pericardial effusion is complicated by cardiac tamponade, it constitutes a medical emergency that requires immediate identification and treatment. Four cases are presented on patients with pericardiac effusions associated with tuberculosis, myxoedema, uraemia, and lupus, and who developed cardiac tamponade.