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Table of Contents   
LETTERS TO EDITOR  
Year : 2016  |  Volume : 9  |  Issue : 3  |  Page : 272-273
Multiple pericardial abscesses in a child with known chronic granulomatous disease


1 Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
2 Department of Pediatric Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

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Date of Web Publication25-Aug-2016
 

How to cite this article:
Kalyoncu AU, Habibi HA, Aslan M, Alis D, Aygun DF, Camcioglu Y, Adaletli I. Multiple pericardial abscesses in a child with known chronic granulomatous disease. Ann Pediatr Card 2016;9:272-3

How to cite this URL:
Kalyoncu AU, Habibi HA, Aslan M, Alis D, Aygun DF, Camcioglu Y, Adaletli I. Multiple pericardial abscesses in a child with known chronic granulomatous disease. Ann Pediatr Card [serial online] 2016 [cited 2020 Aug 13];9:272-3. Available from: http://www.annalspc.com/text.asp?2016/9/3/272/189120


Sir,

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency that affects about 1 in 250,000 individuals.[1] It is known by a defective intracellular killing of phagocytized organisms. Pneumonia was noted in 79%, suppurative lymphadenitis in 53%, whereas subcutaneous abscesses in 52% in these patients.[1] Pericardial involvement is rarely seen in patients with CGD and mostly presented with pericardial effusion rather that abscess.[1] Herein, we present a case of a CGD with diffuse multiple pericardial abscesses, which is diagnosed by cardiac magnetic resonance imaging (MRI).

An 8-year-old child with known CGD was administered to emergency service with cough and chest pain. Chest x-ray showed cardiomegaly and right paracardiac infiltration. Routine biochemical tests were reflected an inflammatory condition (C-reactive protein: 18.8 mg/l, erythrocyte sedimentation rate: 116 mm/h, and white blood cell count: 13 × 103/µl). Ceftriaxone was intravenously administered with diagnosis of pneumonia. Echocardiography was performed to identify potential cause of cardiomegaly. Pericardial effusion including fibrin bands with suspicious lesions suggesting pericardial abscesses in pericardium was identified. For further evaluation of these lesions, cardiac MRI was performed (Avanto, Siemens Medical Systems, Enlargen, Germany). Apart from routine cardiac MRI sequences, diffusion-weighted sequence, which is very reliable MRI technique to demonstrate pericardial abscess, was added to our cardiac MRI examination.[2] Cardiac MRI of the patient revealed multiple pericardial abscesses extending to the left pleura and mediastinum [Figure 1]. In the following days, patient showed symptoms of tamponade, thus urgent pericardiectomy was performed. Pathologic examination of the excised pericardial specimen showed multiple abscesses. Patient died because of cardiac arrest 1 month later despite all the efforts.
Figure 1: Cardiac magnetic resonance imaging of the patient. (a and b) Four-chamber diffusion-weighted sequence and apparent diffusion coefficient (ADC) maps showing diffusion-restricted areas in the pericardium (arrows). (c) Four-chamber T2-weighted sequence (TR-5916 ms: TE-78 ms: FOV 324*384: slice thickness – 8 mm) showing multiple focal hyperintense pericardial abscesses (thin arrow). Also note the bilateral pleural effusion. (d) Delayed T1-weighted contrast-enhanced image (TR-500: TE-7.2: FOV 324*384: slice thickness – 8 mm) demonstrating multiple pericardial abscesses that shows peripheral ring-like contrast enhancement (arrows)

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In conclusion, to our knowledge this is the first article that report a case of a CGD presented with multiple pericardial abscesses. On the basis of our report, we suggested that although cardiac involvement is a very rare condition in patients with CGD, if the clinical findings are supporting cardiac involvement, pericardial abscesses should also be kept in mind in addition to pericardial effusion. We also suggested that using cardiac MRI including diffusion-weighted sequences might be a valuable tool to evaluate the type of pericardial involvement in these patients.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Winkelstein JA, Marino MC, Johnston RB, Boyle J, Curnutte J, Gallin, JI, et al. Chronic granulomatous disease: report on a national registry of 368 patients. Medicine (Baltimore), 2000; 79: 155-69.  Back to cited text no. 1
    
2.
Oyama N, Oyama N, Kamura K, et al. CT and MRI of the pericardium anatomy and pathology. Magn Reson Mod Sci 2004;13:145-52.  Back to cited text no. 2
    

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Correspondence Address:
Deniz Alis
Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.189120

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