Caution: This is a graphic description. In my post on July 2, Aberrant Abscesses – Angola Day 2, I described the plight of a seven-year old boy with pockets of pus erupting in his leg, shoulder and hip. Let’s call him “Lobito.” After drainage of the hip abscess on that date Lobito’s fever and appetite gradually improved. But this progress was unfortunately short lived. Over the weekend Lobito became short of breath and his chest X-ray revealed a new finding: an abnormally round heart size. Yesterday, ultrasound of his heart demonstrated the presence of thick pericardial fluid, represented by the blue line that measures 2 cm in depth where there should be no visible fluid at all.
Yesterday our esteemed surgeon, Annelise Olson, performed a pericardiocentesis – insertion of a needle into the pericardium. Immediately, yellow-green colored pus erupted from the puncture. A large bore catheter we inserted where the needed has been, and in the image above I’m aspirating 300 ml of pus, accumulating in this blue bowl. Almost immediately Lobito’s oxygen requirement predictably decreased as heart, which had been compressed by the pus, began beating freely.
But pyopericarditis is both a rare and a lethal infection. Individuals often die from the overwhelming sepsis and cardiac failure that accompanies the disease. This morning I approached Lobito’s bedside with trepidation. What did I discover? Please judge for yourself from the photo above.