Case:
A 10 week old previously healthy female infant born via spontaneous vaginal delivery (SVD) at full term gestation, who was doing well until 2 months at which time she developed signs and symptoms of URI followed by cough but no fever. While in the medical office the patient went limp after a nasopharyngeal swab test and subsequent cardiopulmonary resuscitation (CPR) was done with return to spontaneous circulation (ROSC) after 2 minutes.
She was transferred to a local Emergency Department where she was intubated with a 3.5 uncuffed tube for concern of severe acidosis and work of breathing. A bedside ECHO showed a large circumferential pericardial effusion (Figure 1) . The infant was transferred to Loma Linda University Children’s Hospital (LLUCH) for higher level of care.
At LLUCH a pericardiocentesis was done and a pigtail was sutured into position and placed on low intermittent suction. A CT Chest with contrast showed a 4.2 x 3.6 x 3.8 cm right sided pericardial/mediastinal hypodense mass with internal calcifications. The heart was shifted to the left due to mass effect. The mass was partially surrounding the aorta and SVC as well as the right pulmonary artery.
Echocardiogram showed normal biventricular systolic function with and EF of approximately 67% with no evidence of flow obstruction. A patent foramen ovale with a small shunt was also found. It also showed a multi-cystic mass appearing on top of the right atrium (Figure 2).
The mediastinal teratoma was excised via sternotomy and pericardiectomy