Effectiveness of intrapericardial fibrinolysis in an infant with purulent pericarditis

A 15-month-old infant was diagnosed with massive pericardial effusion with hemodynamic compromise. A percutaneous pericardiocentesis was performed to evacuate the fluid, revealing purulent content. Pericardial fluid cultures showed Streptococcus pneumoniae, so she was treated with intravenous Cefotaxime during 4 weeks. The patient's hemodynamic situation improved following the evacuation, but 72 h later, there was a deterioration in the cardiac function related to the reappearance of the effusion and the presence of fibrin tracts. Intrapericardial fibrinolysis with rt-PA was performed using the initial pericardial drain, resulting in the evacuation of purulent content and, subsequently, serosanguineous fluid. The patient remained stable after fibrinolysis without recurrence of the effusion, and surgical pericardiectomy was not necessary.