A Ball in The Heart . A 47 days old Libyan Male was presented to our E.R with Bloody Diarrhea , in which it started at the same day of presentation , poor feeding for 2 days ,and coffee ground vomiting , he was admitted to our PICU, the Infant is post NVD Full Term with birth weight 2.4 kg , kept in nursery for 20 days due to Neonatal Sepsis and RDS in which he was connected to Mechanical Ventilation , and received blood transfusion . The father is HIV positive while the mother is HIV negative ,with positive consanguinity . On Examination : he was mottled skin , delay perfusion , pale , weak femoral and peripheral pulses his B.P = 110/74(80) Dismorphic features , fair skin , bilateral club foot , hydrocephaly with flat occipit , low set ears, wide space nipple , bilateral Hydrocele , long fingers , liver was palpable about 2 cm below coastal margin . 3 shots of normal saline given , vit. K Tranexamic Acid , connected to NIV , omeprazole , septrin and ciprofloxacin started , Dexamethasone , CD4 , CD8 were sent , Viral screen done , His HB = 6.9 , HCT= 20 , WBC= 19 , PLT = 70 , CRP = 15.7 , PCT = 1.O3 , UREA = 57 , CRT. = 0.2 , BILT. = 10.9 , and normal LFT His PRISM score was 80 % , Down score 3 his ABG was Normal , he had Hypoglycemic Attack despite of giving him shots of dextrose , with all this he still bleeding , Fresh blood , so Novaseven (factor VII )Given ,PRBCs, F.F.P. On the 2nd day of Admission , Elective intubation done , and right subclavian central Line inserted , And 10 % dextrose started . ECHO Done , and it showed : Situs Solitus heart in Dextroposition AV-VA associated with RV+ RA , Mild Tricuspid Requrge , PPG 35 MMHG , Theres Solid mass 17*8 mm ( almost like a potato ) , showed Echogenicity like myocardium , looks in papillary muscles. Dilatation of coronary sinus suggesting PLSVC , Cardiac RV cavity mass ( ? Tumor ) with mild congestive heart failur . Next step done to that Infant to reach Diagnosis is C-T scan with contrast done for chest , Abdomen , pelvis and Brain , A full Skeletal Servery done . So D/D were : 1-Tumor . 2- vegetation 3- thrombus . A low dose of Fraxiparins S.C was given , his PT. APTT and INR Returned almost to normal range . sawbs that was taken form him showed growth of Klebsilla . Antibiotics changed to ciprofloxacinand meropenem , and kept on F.F.P ( daily ) After 48 hours of Admission the bloody Diarrhea stopped After 72 hours his CBC was HB= 10.5 , HCT = 28.6 , WBC= 13 , PLT = 438 , CRP = 3 , PCT= 0.5 , UREA = 35 , PT .APTT ,INR Returned all to Normal values . after 3 days Fraxiparin stopped , planned for MRI HEART , And the baby was Transferred to TMC to Oncology Department. with all sorrow the baby didnt make it and he died without reaching Diagnosis . You can see in Video below the size of Tumor taken by an Echo . And a Picture posted in the first comment Submitted By Dr. Sara Ben Haliem
Posted on: Wed, 06 Aug 2014 17:46:22 +0000
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