An Interesting Case of Viral Pericarditis.

A previously healthy 14-year-old girl presented to the emergency department with a 3-day history of upper respiratory symptoms and 2 syncopal episodes. She was initially febrile, tachycardic, and tachypneic; the initial electrocardiogram showed diffuse T-wave inversions and right atrial enlargement. There was no pericardial effusion on bedside and formal echocardiography; the latter, however, revealed a hyperechogenic pericardium. A viral swab was positive for influenza B. Treatment with intravenous rehydration and ibuprofen was started with good response. The patient went home 24 hours later with the diagnosis of mild pericarditis and syncope likely secondary to dehydration impaired diastolic filling.The incidence of acute pericarditis in previously healthy children is unknown. There are no known case reports of influenza B-associated pericarditis in the pediatric population. There is little high quality evidence to guide the diagnosis and management of pericarditis in children. However, limited data suggest that the typically described presentation of chest pain, pericardial rub, pericardial effusion, and electrocardiogram changes occurs in children. The pediatric population seems to respond well to nonsteroidal anti-inflammatory drugs.

Distinctive neck swelling in a patient with a vein of Galen arteriovenous malformation.

A vein of Galen arteriovenous malformation (VGAM) is a rare intracranial shunt lacking a capillary bed and resulting in subsequent aneurysmal enlargement. VGAM has been previously reported to present as cardiovascular abnormalities, including increased right-sided cardiac load and pressure, cardiac dilatation, pulmonary hypertension and retrograde flow into the aortic arch. We report the first case of VGAM presenting as a gross right-sided neck swelling in a 39-week-old immediately at birth. Transthoracic echocardiography detected dilatation of the superior vena cava and innominate vein, increased right ventricular and pulmonary arterial pressure, and retrograde flow into the aortic arch. Follow-up neck ultrasound revealed tortuous carotid artery and bilateral dilatation of neck veins. Transcranial ultrasound revealed abnormally dilated vessels posterior to the third ventricle, confirming VGAM. Our case demonstrates that while the differential diagnoses of neck swelling are extensive, such a presentation upon Doppler and echocardiographic investigation, may be suggestive of extracardiac causes such as VGAM. The management of such a condition remains critical due to risk of hemorrhage and extensive cerebral involvement.