Abstract :
Myxedema heart disease is a well known entity.
Pericardial effusions have been reported in 50-73% of
pediatric patients with hypothyroidism in various
series[1,2], but none of these describes the
symptomatic pericardial effusions or cardiac
tamponade.
5 year female child presented with complaints of
periorbital puffiness and mild abdominal distension
intermittently for last 6 months. She was
symptomatically treated with diuretics off and on
without much benefit. This time she reported to
pediatric emergency with progressively increasing
respiratory distress for last 5 days. There was no
history of any fever, decreased urine output,
orthopnea, or Koch’s contact. She was third live issue
of non consanguineous marriage born by normal
vaginal delivery following uncomplicated pregnancy.
She was immunized for age with no significant
family history. She had history of global development
delay, development age corresponded to 3 years. On
examination she was afebrile with HR of 70/min, RR
of 44/min and BP of 80/60 mmHg with pulsus
paradoxus. She had coarse facies with dilated neck
veins. Her skin was dry and coarse. She had short
stature with height less than 3rd centile and normal
weight. Her cardiovascular examination revealed
silent precordium. Her cardiac border was extending
1.5 cm beyond right sternal margin and 2 cm beyond
apex beat on left side on percussion. Her heart sounds
were muffled with no murmur.
