Point-of-Care Ultrasound in Paediatric Cardiac Tamponade: A Case Report of Rapid Diagnosis and Guided Pericardiocentesis in a Resource-Limited Setting.

Abstract

The case report demonstrates the utility of point-of-care ultrasound (POCUS) for both diagnosis and ultrasound-guided intervention in managing cardiac tamponade in a paediatric patient. A 10-year-old child presented with a six-week history of cough, weight loss, and a two-week history of respiratory difficulty, orthopnoea, and generalized body swelling, starting in the legs. He had progressive easy fatigability over the last three months. An external chest X-ray indicated a globular heart, suggestive of pericardial effusion to rule out cardiomyopathy. Cardiac POCUS revealed a massive pericardial effusion with tamponade physiology. Immediate ultrasound-guided pericardiocentesis was performed, draining 800 ml of purulent fluid, followed by an additional 200 ml with an underwater seal setup. Post-procedure, serial POCUS examinations were conducted to monitor for adequate drainage and to detect any possible re-accumulation of pericardial fluid. The symptoms resolved, and a 2-week follow-up showed sustained improvement. This case underscores the vital role of POCUS in both the prompt diagnosis and safe, accurate ultrasound-guided pericardiocentesis in emergent cardiac care for paediatric patients.