Author Of 2 Presentations
ACUTE SEVERE MYOCARDITIS WITH EXTENSIVE CARDIAC THROMBUS FORMATION IN A TEENAGE BOY: A THERAPEUTIC CHALLENGE
Abstract
Background
Acute myocarditis is a rare condition in pediatrics, but potentially lethal, that can culminate in cardiac disfunction and, rarely, intracardiac thrombus.
Objectives
Not Applicable
Methods
Not Applicable
Results
We report the case of a 16-year-old teenage male, previously healthy, that was transfered to the Pediatric Intensive Care Unit due to suspicion of acute myocarditis with multiorgan disfunction. Echocardiogram at admission revealed moderate to severe left ventricular (LV) disfunction (ejection fraction of 30-35%) and two hyperechoic masses in the LV suggestive of thrombus, given which he initiated non-fractionated heparin. The cardiac magnetic resonance at day 4 was compatible with acute myocarditis with moderate to severe ventricular disfunction and biventricular thrombus. Of the infectious investigation, the only relevant finding was a positive fecal culture for Campylobacter jejuni; remaining microbiological, immunological, and prothrombotic studies were negative. Despite the treatmentwith ceftriaxone, azithromycin and IV immunoglobulin, there was an increase of the thrombus, with decline of cardiac function and peripheric arterial embolization, which led to surgical thrombectomy on day 13. He was maintained on extracorporeal membrane oxygenation until day 28, when he was subjected to orthotopic cardiac transplant with no complications. Evolution was favorable, with progressive improvement of cardiac function and no recurrence of thrombus.
Conclusion
We present a case of acute myocarditis complicated with intracardiac thrombus and systemic embolization. The approach to these cases should be multifactorial and multidisciplinary and the decision of surgical treatment is difficult. Despite severe cardiac dysfunction and intraoperative risk of embolization, the surgery was successful and should be considered in the absence of improvement with medical treatment.
WEAPON RELATED TRAUMA IN A PEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Trauma in Portugal continues to be one of the main causes of death in children and adolescents. Yet, there is a shortage of population-based studies about weapon related trauma in our country.
Objectives
To describe patients hospitalized for weapon related trauma in a Portuguese Pediatric Intensive Care Unit.
Methods
Retrospective study through clinical processes analysis of hospitalized cases for a period of 10 years (January 2006 to December 2017).
Results
Were included 9 cases, 88,9% were male and mean age was 11,3 years. A firearm was used in 66.6% and a white weapon in the remaining cases, 44.4% happened at home, mainly on weekend. Two cases were suicide attempts while in the others the aggressor was either a friend, family or a neighbor. In 5 cases the aggression was intentional, 55,6% the injury was in the head, whereas the rest was in abdomen, back or neck. During hospitalization, all patients were intubated, 5 underwent surgery and 4 required inotropic and transfusional support. Median length of stay was 14,5 days. Overall mortality was 22,2%, corresponding to a 5 and a 14-year-old male, both with severe traumatic brain injury. Of those two patients, Pediatric Risk of Mortality calculated through PRIM III score was 29 and 30 and probability of death was 0.597 and 0.673, respectively. One patient persisted with major sequels and one with minor.
Conclusion
Weapon injuries in children can be associated with severe adverse outcomes including death, which makes this a significant public health problem and a focus to prevention measures in risk groups.