Huang Lei, Zhou Quan, Cui Xiaoqiong, Hu Xiaomin, Duan Dawei, Wu Peng, Gao Wenqing, Ning Meng, Li Tong
Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.
Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.
Transl Pediatr. 2021 Jan;10(1):209-214. doi: 10.21037/tp-20-203.
Constrictive pericarditis in children is exceedingly rare, and may cause very problematic confusion of diagnosis and etiology identification. In this case, we examined a 14-year-old female patient who had developed signs of significant anasarca which was eventually turned out to be constrictive pericarditis. Affected by the experience of examiners, the patient was not diagnosed or even suspected with constrictive pericarditis when she was initially examined by echocardiography in the hospital where she visited before. Reexamination of echocardiography, cardiac catheterization and non-invasive image techniques were performed to establish the diagnosis finally. Open pericardectomy was ultimately performed and normal hemodynamic parameters and cardiac function were obtained postoperatively. In the determination of etiology, we inferred that chronic infection induced by local virus infection in the pericardium led to constrictive pericarditis. Parvovirus B19 (PVB19) and/or human herpes virus 6 (HHV-6) were the two most likely viruses involved based on published literature reviews. Importantly, we learned that serological antibody testing may be false-negative and polymerase chain reaction (PCR) or metagenomic next-generation sequencing for pericardial viral nucleic acid testing may be the gold standard for confirmation. Unfortunately, fresh pericardial tissue samples were not taken before paraformaldehyde fixation in our case, which made it impossible for us to detect suspicious viruses. We do hope that the lessons learned from this case will be helpful and instructive for the etiological diagnosis of similar patients in the future.
儿童缩窄性心包炎极为罕见，可能导致诊断和病因识别方面的严重混淆。在本病例中，我们检查了一名14岁女性患者，她出现了明显的全身性水肿迹象，最终被诊断为缩窄性心包炎。受检查者经验的影响，该患者在之前就诊的医院初次接受超声心动图检查时，并未被诊断出甚至怀疑患有缩窄性心包炎。最终通过再次进行超声心动图检查、心导管检查和非侵入性影像技术来确立诊断。最终实施了心包切除术，术后获得了正常的血流动力学参数和心功能。在病因确定方面，我们推断心包局部病毒感染引起的慢性感染导致了缩窄性心包炎。根据已发表的文献综述，细小病毒B19（PVB19）和/或人疱疹病毒6（HHV-6）是最有可能涉及的两种病毒。重要的是，我们了解到血清学抗体检测可能为假阴性，而心包病毒核酸检测的聚合酶链反应（PCR）或宏基因组下一代测序可能是确诊的金标准。不幸的是，在我们的病例中，新鲜心包组织样本在甲醛固定前未采集，这使得我们无法检测可疑病毒。我们衷心希望从该病例中吸取的经验教训能对未来类似患者的病因诊断有所帮助和指导。
