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Pericardite numa urgência pediátrica
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A pericardite aguda (PA) é uma entidade rara nas crianças e consiste na inflamação do pericárdio. A etiologia pode ser dividida em causas infecciosas e não infecciosas, sendo a pericardite viral/idiopática a mais frequente. O objetivo deste estudo é caracterizar a forma de apresentação, diagnóstico, terapêutica e outcomes dos doentes internados com pericardite aguda no Serviço de Urgência de Pediatria (SUP) de um hospital terciário. Métodos: estudo retrospetivo, observacional, dos doentes em idade pediátrica que foram admitidos no SUP de um hospital terciário, entre 2017 e 2022. Foram analisados dados demográficos, manifestações clínicas, exames complementares de diagnóstico, terapêutica instituída e seguimento, sendo estes obtidos através da consulta de registos do processo clínico dos doentes. Resultados: Foram identificados dezassete doentes, predominantemente do sexo masculino (70,6%), com uma mediana de idades de 13 anos. A pericardite aguda e a miopericardite foram os diagnósticos mais frequentes (41,2%). A maioria dos doentes apresentaram toracalgia (88,2%), 10 apresentaram febre (58,8%) e 9 apresentaram sintomas flu-like (52,9%). Nos exames complementares de diagnóstico realizados foram observados: cardiomegália na radiografia do tórax em 5 doentes (29,4%), alterações no eletrocardiograma compatíveis com PA em todos os doentes e derrame pericárdico no ecocardiograma transtorácico em 9 doentes (52,9%). A etiologia mais comum foi idiopática (41,2%), seguida de infecciosa – SARS-CoV2, S. agalactiae e S. pyogenes (29,4%), secundária a doenças auto-imunes – LES e AIJ (17,6%) e secundária a fármacos (11,8%). A primeira linha terapêutica foi o ibuprofeno (70,6%). A pericardiocentese foi realizada em 2 doentes. Em 3 doentes ocorreu recorrência dos sintomas (17,6%). Conclusões: Verificou-se que a causa mais frequente continua a ser idiopática/presumivelmente viral. Foram detetados 3 casos após infeção COVID-19 e 2 casos secundários a fármacos. Em 41,2% dos casos ocorreu afeção concomitante do miocárdio. A recidiva não é desprezível sendo importante estudar o papel da colchicina e dos corticosteroides em crianças.
Acute pericarditis is a rare entity in children and consists of inflammation of the pericardium. The etiology can be divided into infectious and non-infectious causes, with viral/idiopathic pericarditis being the most frequent. The objective of this study is to characterize the presentation, diagnosis, therapy, and outcomes of patients hospitalized with acute pericarditis in the Pediatric Emergency Service (SUP) of a tertiary hospital. Methods: retrospective, observational study of patients of pediatric age who were admitted to the SUP of a tertiary hospital, between 2017 and 2022. Demographic data, clinical manifestations, complementary diagnostic tests, established therapy and follow-up were analyzed, which were obtained through the consultation of patient clinical file records. Results: Seventeen patients were identified, predominantly male (70,6%), with a median age of 13 years. Acute pericarditis and myopericarditis were the most frequent diagnoses (41,2%). Most patients had chest pain (88,2%), 10 had fever (58,8%) and 9 had flu-like symptoms (52,9%). In the complementary diagnostic tests performed, the following were observed: cardiomegaly on chest X-rays in 5 patients (29,4%), changes in the electrocardiogram compatible with BP in all patients and pericardial effusion on the transthoracic echocardiogram in 9 patients (52,9%). The most common etiology was idiopathic (41,2%), followed by infectious – SARS-CoV2, S. agalactiae and S. pyogenes (29,4%), secondary to autoimmune diseases – SLE and JIA (17,6%) and secondary to drugs (11,8%). The first therapeutic line was ibuprofen (70,6%). Pericardiocentesis was performed in 2 patients. In 3 patients there was recurrence of symptoms (17,6%). Conclusions: It was found that the most frequent cause continues to be idiopathic/presumably viral. 3 cases were detected after COVID-19 infection and 2 cases secondary to drugs. In 41,2% of the cases there was concomitant myocardial affection. Recurrence is not negligible, and it is important to study the role of colchicine and corticosteroids in children.
Acute pericarditis is a rare entity in children and consists of inflammation of the pericardium. The etiology can be divided into infectious and non-infectious causes, with viral/idiopathic pericarditis being the most frequent. The objective of this study is to characterize the presentation, diagnosis, therapy, and outcomes of patients hospitalized with acute pericarditis in the Pediatric Emergency Service (SUP) of a tertiary hospital. Methods: retrospective, observational study of patients of pediatric age who were admitted to the SUP of a tertiary hospital, between 2017 and 2022. Demographic data, clinical manifestations, complementary diagnostic tests, established therapy and follow-up were analyzed, which were obtained through the consultation of patient clinical file records. Results: Seventeen patients were identified, predominantly male (70,6%), with a median age of 13 years. Acute pericarditis and myopericarditis were the most frequent diagnoses (41,2%). Most patients had chest pain (88,2%), 10 had fever (58,8%) and 9 had flu-like symptoms (52,9%). In the complementary diagnostic tests performed, the following were observed: cardiomegaly on chest X-rays in 5 patients (29,4%), changes in the electrocardiogram compatible with BP in all patients and pericardial effusion on the transthoracic echocardiogram in 9 patients (52,9%). The most common etiology was idiopathic (41,2%), followed by infectious – SARS-CoV2, S. agalactiae and S. pyogenes (29,4%), secondary to autoimmune diseases – SLE and JIA (17,6%) and secondary to drugs (11,8%). The first therapeutic line was ibuprofen (70,6%). Pericardiocentesis was performed in 2 patients. In 3 patients there was recurrence of symptoms (17,6%). Conclusions: It was found that the most frequent cause continues to be idiopathic/presumably viral. 3 cases were detected after COVID-19 infection and 2 cases secondary to drugs. In 41,2% of the cases there was concomitant myocardial affection. Recurrence is not negligible, and it is important to study the role of colchicine and corticosteroids in children.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Pericardite Pericárdio Doenças do pericárdio Criança Pediatria