An unusual presentation of cardiac tamponade

Pericardial tamponade presenting as abdominal pain in a patient with systemic lupus erythematosis

Abdominal pain is a common complaint in children presenting to the emergency department. Patients with systemic lupus erythematosus (SLE) are at increased risk of infection, bowel necrosis and perforation, especially if they are taking nonsteroidal anti-inflammatory drugs, corticosteroids or immunosuppresive agents, which may mask the signs and symptoms of the underlying condition, hence delay diagnosis and treatment. This article presents the case of an adolescent girl whose abdominal pain was related to cardiac tamponade and provides an overview of the cardiac and gastrointestinal manifestations of SLE.

Survival following cardiac tamponade and arrest in a paediatric patient with penetrating trauma to pulmonary artery

A seven-year-old child with an airgun pellet injury to the upper part of the anterior chest wall was transported in a state of shock from a nearby hospital to this trauma centre. The nature and site of injury associated with engorged neck veins, hypotension, pulsus paradoxus and an enlarged liver suggested the possibility of acute pericardial tamponade. On arrival in the emergency room the child had a brief period of cardiac arrest revived by basic resuscitation procedures. Pericardiocentesis was negative in the emergency room. Emergency median sternotomy with pericardiotomy was done to relieve the tamponade which was peroperatively diagnosed to be due to a tear in the pulmonary artery close to its origin. Early clinical diagnosis, rapid surgical intervention in the operating room and efficient anaesthetic management within the 'Golden Hour' saved life. It is believed that this is the first report of survival of a paediatric patient with a gunshot penetrating trauma to the pulmonary artery leading to cardiac tamponade and a brief period of cardiac arrest.