Echocardiography is the most specific and useful diagnostictest for detection of pericardial effusions. A chest x-ray mayreveal cardiomegaly. A large effusion creates a rounded, globular cardiac silhouette. The electrocardiogram (ECG) may showtachycardia, elevated ST segments, reduced QRS voltage orelectrical alternans (variable QRS amplitude). The causative organism may be identified through viral titers, antistreptolysin O (ASO) titers, or diagnostic testing of the pericardial fluid.
Pericardiocentesis is indicated for treatment of hemodynamically significant effusions and to determine the etiology of the pericarditis. Additional treatment is directed at the specific etiology. There is no specific treatment for viral pericarditis other than antiinflammatory medications.
Kliegman RM, Behrman RE, Jenson HB, et al: Nelson Textbook of Pediatrics, ed 19, Philadelphia, 2011, Saunders
Lai WW, Mertens LL, Cohen MS, Geva T: Echocardiography in Pediatric and
Congenital Heart Disease: from Fetus to Adult, Oxford, UK, 2009, Blackwell
Moller JH, Hoffman JI, Benson DW, Van Hare GF, Wren C: Pediatric Cardio vascular Medicine, ed 2, West Sussex, UK, 2012, Wiley-Blackwell
Shaddy RE: Heart Failure in Congenital Heart Disease, London, 2011, Springer
Wren C: Concise Guide to Pediatric Arrhythmias, West Sussex, UK, 2012,
Julie A. Panepinto, Rowena C. Punzalan, and J. Paul Scott 20
A detailed history of the onset, severity, progression, associated symptoms, presence of systemic complaints, and exacerbating factors is crucial to the diagnosis of a blood disorder. In many blood disorders, a detailed pedigree identifying a pattern of inheritance can point to the diagnosis.
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Jaundice Anemia Bleeding Petechiae/Purpura Pancytopenia Failure to Thrive
The physical examination of patients with blood disordersfirst focuses on hemodynamic stability. Acute episodes ofanemia may be life-threatening, presenting with impairment of perfusion and cognitive status. The two mostcommon findings of anemia include pallor and jaundice. The presence of petechiae, purpura, or deeper sites of bleeding, including generalized hemorrhage, indicatesabnormalities of platelets, coagulation factors, or both.Growth parameters point to whether anemia is an acuteor chronic process. Severe types of anemia, thrombocytopenia, and pancytopenia often are associated with congenital anomalies and a pattern of growth delay. Organsystem involvement (especially hepatosplenomegaly and lymphadenopathy) or systemic illness point to a generalized illness as the cause for hematologic abnormalities(Table 149-1).
Diagnosis of pediatric blood disorders requires a detailed knowledge of normal hematologic values and varies according to ageand, after puberty, according to sex (Table 149-2). Directed bythe history, physical examination, and screening laboratorystudies, specific diagnostic testing can confirm the diagnosis.