Question
8-year-old boy with pulmonary kochs on ATT since 2 months presents with an acute onset breathlessness and chest pain.O/E there was mild hepatomegaly, muffled heart sounds, hypotension, and jugular venous distension. A chest radiograph is attached. What is the most likely clinical scenario here and what is the next best investigation:
| A. |
Congestive Cardiac Failure, Echo
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| B. |
Pericardial Effusion, Echo
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| C. |
Drug Induced Cardiomyopathy, Echo
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| D. |
Massive Tubercular Effusion, Ct Chest
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Show Answer
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Correct Answer � B
Explanation
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Ans. B. Pericardial Effusion, Echo
Muffled heart sounds, hypotension, and elevated JVP is the classic Becks triad of pericardial effusion. In this clinical vignette, the probable cause for that would be tubercular dissemination to pericardium causing heart failure manifestations. This could happen with ATT non-compliance or an MDR TB. Echocardiography is the next best investigation to confirm this clinical scenario as the cardiomegaly on a chest radiograph is not very specific. This large cardiac window on the chest radiograph is referred to as a money bottle heart seen in massive pericardial effusion.
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