This is a 10 year-old boy presented with chest pain, associated with worsening severe breathlessness for 2 days, with history of URTI symptoms about 2 weeks ago. He was in respiratory distress and was nearly intubated. ECHO showed dilated 4 chambers, severe MR/TR with pericardial effusion. (Btw, hence the CXR features- globular heart shape)
I guess you're having something in your mind? Ya he's treated as Rheumatic carditis.
End of story? No it's not. I had a feeling that there's somethin more.
If you do notice, there's associating pulmonary congestion, and dilated all chambers shouldn't occur so fast, if it's just a first onset acute rheumatic fever.
So I did some further questioning. I asked the child and his parents that whether he had any similar febrile illness before. They took some times to recall, and finally gave a history that, at his age of 4, he had an episode of high grade fever, associated with joint pain which was "migratory", but he did not seek any treatment. He was well for a period of time, then started to have intermittent chest pain, fatigue and exertional dyspnea, but he thought he's just being "weak" and did not pay much attention to it.
And that matches the whole picture. A massively dilated heart with pulmonary congestion points more to a chronic condition, and this child was actually having rheumatic carditis, but it was an acute on chronic condition.
He responded well to treatment and currently awaiting to see the paeds cardiologist in IJN soon=)