Pericardiectomy in post-traumatic suppurative constrictive pericarditis: case report

A 13-year-old male was seen at the Hospital with a 5-months history of right chest swelling, pain and recurrent fever and breathlessness on mild exertion. There was a history of gunshot to his chest two and half years before presentation. On admission he was febrile with a temperature of 39°C. The chest wall swelling measuring 6 cm/6 cm was tender and fluctuant and needle aspiration yielded purulent fluids. His blood pressure and pulse were 110/60 mmHg (14.6/8 Kpa) and 100 per minute respectively. The chest radiograph showed massive cardiomegaly with pellets lodging in the right 5(th )costosternal joint. Echocardiography confirmed massive pericardial effusion. The electrocardiogram showed sinus rhythm and low voltage of QRS complexes without chamber enlargement. A diagnosis of constrictive pericarditis with purulent pericardial effusion secondary to foreign body abscess was made. His clinical picture improved after an initial incision and drainage of the right anterior chest wall abscess under ketamine intravenous anaesthesia. Two weeks after, he had pericardiectomy under general anaesthesia using a nitrous/oxygen/halothane relaxant technique which was uneventful.