Pediatric Annals

Case Challenges 

A 17-year-old Girl with Increasing Respiratory Distress

Robert Listernick, MD

  • Pediatric Annals. 2007;36(4)
  • Posted April 1, 2007

Abstract

This 17-year-old girl was admitted to the intensive care unit because of increasing respiratory distress over the previous two weeks. Two weeks prior to admission, she started developing progressive respiratory distress and swelling in her right leg. She had difficulty climbing stairs and increasing exercise intolerance. There was a vague history of intermittent fevers without rash, cough, vomiting, diarrhea, or other symptoms. At an outside hospital, her oxygen saturation was 57% in room air, and a limited echocardiogram revealed a moderate pericardial effusion. Due to deterioration in her respiratory status, she underwent endotracheal intubation and was transferred.

Key Learning Points

  1. Vascular lesions can be divided into two main categories —malformations and tumors. Tumors are true proliferative neoplasms, the most classic of which is the infantile hemangioma.
  2. Malformations are non-proliferative collections of dilated or excess blood vessels, usually present at birth. They are named for the predominant vessel within the lesion, whether it’s a capillary, vein, or lymphatic vessel. They may have combinations of blood vessels, such as an arteriovenous malformation or a capillary-lymphatic-venous malformation.
  3. Kasabach-Merritt phenomenon refers to the combination of a vascular neoplasm with consumptive coagulopathy and thrombocytopenia. Contrary to popular belief, this does not usually occur within hemangiomas of infancy but rather occurs with Kaposiform hemangioendothelioma or tufted angioma.
  4. The three most likely causes of infectious pericarditis are bacterial, viral, and mycobacterial.
  5. The diagnosis of SLE requires the presence of four or more of the classic features listed in the Sidebar.

ABOUT THE AUTHOR

Dr. Listernick is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

Abstract

This 17-year-old girl was admitted to the intensive care unit because of increasing respiratory distress over the previous two weeks. Two weeks prior to admission, she started developing progressive respiratory distress and swelling in her right leg. She had difficulty climbing stairs and increasing exercise intolerance. There was a vague history of intermittent fevers without rash, cough, vomiting, diarrhea, or other symptoms. At an outside hospital, her oxygen saturation was 57% in room air, and a limited echocardiogram revealed a moderate pericardial effusion. Due to deterioration in her respiratory status, she underwent endotracheal intubation and was transferred.

Key Learning Points

  1. Vascular lesions can be divided into two main categories —malformations and tumors. Tumors are true proliferative neoplasms, the most classic of which is the infantile hemangioma.
  2. Malformations are non-proliferative collections of dilated or excess blood vessels, usually present at birth. They are named for the predominant vessel within the lesion, whether it’s a capillary, vein, or lymphatic vessel. They may have combinations of blood vessels, such as an arteriovenous malformation or a capillary-lymphatic-venous malformation.
  3. Kasabach-Merritt phenomenon refers to the combination of a vascular neoplasm with consumptive coagulopathy and thrombocytopenia. Contrary to popular belief, this does not usually occur within hemangiomas of infancy but rather occurs with Kaposiform hemangioendothelioma or tufted angioma.
  4. The three most likely causes of infectious pericarditis are bacterial, viral, and mycobacterial.
  5. The diagnosis of SLE requires the presence of four or more of the classic features listed in the Sidebar.

ABOUT THE AUTHOR

Dr. Listernick is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

This 17-year-old girl was admitted to the intensive care unit because of increasing respiratory distress over the previous two weeks. Two weeks prior to admission, she started developing progressive respiratory distress and swelling in her right leg. She had difficulty climbing stairs and increasing exercise intolerance. There was a vague history of intermittent fevers without rash, cough, vomiting, diarrhea, or other symptoms. At an outside hospital, her oxygen saturation was 57% in room air, and a limited echocardiogram revealed a moderate pericardial effusion. Due to deterioration in her respiratory status, she underwent endotracheal intubation and was transferred.

Key Learning Points

  1. Vascular lesions can be divided into two main categories —malformations and tumors. Tumors are true proliferative neoplasms, the most classic of which is the infantile hemangioma.
  2. Malformations are non-proliferative collections of dilated or excess blood vessels, usually present at birth. They are named for the predominant vessel within the lesion, whether it’s a capillary, vein, or lymphatic vessel. They may have combinations of blood vessels, such as an arteriovenous malformation or a capillary-lymphatic-venous malformation.
  3. Kasabach-Merritt phenomenon refers to the combination of a vascular neoplasm with consumptive coagulopathy and thrombocytopenia. Contrary to popular belief, this does not usually occur within hemangiomas of infancy but rather occurs with Kaposiform hemangioendothelioma or tufted angioma.
  4. The three most likely causes of infectious pericarditis are bacterial, viral, and mycobacterial.
  5. The diagnosis of SLE requires the presence of four or more of the classic features listed in the Sidebar.

ABOUT THE AUTHOR

Dr. Listernick is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

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