Case Description:
We present a 2 kg preterm female with a large prenatally diagnosed
posterior intrapericardial mass concerning for teratoma, without signs
of hydrops on prenatal ultrasound which confers lower morbidity and
mortality 6.
The infant was born via spontaneous vaginal delivery at 33w6d gestation
in the setting of preterm labor and was successfully intubated at minute
3-4 of life. Apgars at 1 and 5 minutes of life were 3 and 7,
respectively. UVC and UAC were placed, labs obtained, prostaglandins
started while awaiting formal echocardiography, and patient transferred
to paediatric cardiac ICU for further management. Postnatal echo,
MRA/MRI confirmed findings of a 4.3cm x 3.6cm x 3.5cm mass displacing
the heart within in a massive pericardial effusion. The mass was
intimately related to the roof of bilateral atria, the ascending aorta,
main and right pulmonary artery, and right coronary artery. There was
mass effect causing compression the superior vena cava, leftward
displacement of the left pulmonary artery, anterior leftward
displacement of the aorta, and mild narrowing in the distal trachea, all
without evidence of tamponade (Fig 1-2). Preoperative alpha-fetoprotein
level was greater than 145,000 ng/mL.
On DOL2, hypotension in the cardiac ICU prompted initiation of dopamine
infusion, bedside drainage of 60mL of pericardial effusion with
placement of a pericardial drain.