Hi all, I would appreciate some reassurance on this case. After much deliberating, I am quite convinced that this is PPDH.

– 6 y old, FN, DSH. Adopted 1 year ago from stray life in a community carpark. History of on and off vomiting of undigested food. Normal stools. When playing she is not really very active. No respiratory sings.

-Exam: no heart murmurs. Mild pot belly. No other significant findings. Laboratory findings WNL.

Hi all, I would appreciate some reassurance on this case. After much deliberating, I am quite convinced that this is PPDH.

– 6 y old, FN, DSH. Adopted 1 year ago from stray life in a community carpark. History of on and off vomiting of undigested food. Normal stools. When playing she is not really very active. No respiratory sings.

-Exam: no heart murmurs. Mild pot belly. No other significant findings. Laboratory findings WNL.

-Xrays: incidental finding of rounded cardiac silhouette. It appears asymmetrical and dis-homogeneous lucidency on the lateral view and made me thick of not typical pericardial effusion.

-Echo: I do not find enough findings that can suggest pericardial effusion due to cardiogenic-neoplastic origin. Liver appears to be in direct contact with cardiac tissue. Hepatic silhouette appears mildly abnormal in abdominal approach, like something is missing…

-Questions:

1- Is there any possibility this is not PPDH but just a simple DH? Or any other DDx to consider? Sometimes I struggle to identify pericardium. If I see effusion a bit around atriums and aorta is that still possible with PPDH?

2-How can I be sure of diagnosis? is CT scan needed? I can re-scan this patient and try some tricks-new views if needed.

3- I do not see abnormalities in heart…do you agree?

Thanks so much for input.