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.