Citation Information :
Barrios N, Velázquez E, Velazquez F, Maidana M, Bordón J. Not Every Massive Cardiomegaly in a Newborn Infant is due to an Ebstein's Anomaly or a Large Pericardial Effusion. 2024; 3 (3):233-237.
In neonates, massive cardiomegaly on chest X-rays is an infrequent but concerning finding. These observations are ascribed most frequently to tricuspid valve malformations as in Ebstein's anomaly and to large pericardial effusions. We recently treated a 40 weeks/3 kg male infant born to a 23-year-old primigravida mother after an uneventful, carefully followed pregnancy. The infant developed respiratory distress soon after birth, and a massively enlarged cardiac silhouette was noted on initial evaluation. We investigated the aforementioned possibilities of Ebstein's anomaly or a massive pericardial effusion, but this infant turned out to have a large intrathoracic cystic mass in the left hemithorax. The differential diagnosis was a bronchogenic vs gastrointestinal duplication cyst. The mediastinum was displaced towards the right side. The heart and major vessels were all normal in size. On postnatal day 8, a left posterolateral thoracotomy was performed, and a giant cystic tumor was dissected. There was a tense capsule attached to the lower lobe of the left lung, posterior pleura, esophagus, descending aortic artery, and diaphragm. The surrounding lung tissue was largely intact. Histopathology of the cyst wall showed features of both gastric and small intestinal mucosa, which was consistent with the findings seen in a broad group of anomalies known as bronchopulmonary foregut malformations. We need to consider a wider list of entities in the differential diagnosis of a massively enlarged cardiac silhouette in an infant with respiratory distress.
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