Fatal coronary artery anomaly presenting as bronchiolitis

During winter outbreaks of respiratory syncytial virus bronchiolitis from 2002 to 2004, three infants presented with a presumptive diagnosis of lower respiratory tract infection and wheezing. The clinical condition in two cases was rapidly progressive and precipitated into intractable shock; clinica...

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Bibliographic Details
Published in:European journal of pediatrics 2005-08, Vol.164 (8), p.515-519
Main Authors: PIASTRA, Marco, POLIDORI, Giancarlo, DE CAROLIS, Maria Pia, TEMPERA, Alessia, CARESTA, Elena, PULITANO, Silvia, CHIARETTI, Antonio, VALENTINI, Piero, DE ROSA, Gabriella
Format: Article
Language:English
Subjects:
Aortography
Biological and medical sciences
Bronchiolitis, Viral - complications
Bronchiolitis, Viral - diagnosis
Bronchiolitis, Viral - therapy
Cardiac Catheterization
Chronic obstructive pulmonary disease, asthma
Coronary Vessel Anomalies - complications
Coronary Vessel Anomalies - diagnosis
Coronary Vessel Anomalies - diagnostic imaging
Echocardiography
Fatal Outcome
Female
General aspects
Humans
Infant
Male
Medical sciences
Pneumology
Respiratory Syncytial Virus Infections - complications
Respiratory Syncytial Virus Infections - diagnosis
Respiratory Syncytial Virus Infections - therapy
Shock, Cardiogenic - etiology
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Summary:During winter outbreaks of respiratory syncytial virus bronchiolitis from 2002 to 2004, three infants presented with a presumptive diagnosis of lower respiratory tract infection and wheezing. The clinical condition in two cases was rapidly progressive and precipitated into intractable shock; clinical and instrumental examinations revealed a cardiac origin of their illness. A subacute presentation permitted a cardiological assessment and a proper treatment in the third infant. An abnormal origin of the left coronary artery from the pulmonary trunk was demonstrated in all cases. The concurrent acute airway infection had a catastrophic effect on the underlying cardiovascular anomaly leading to refractory cardiogenic shock and death. Admission chest X-ray film and arterial gas analysis can raise the suspicion of cardiac involvement when treating a severe wheezing episode in young infants. Paediatric cardiological evaluation with two-dimensional echocardiography may eventually reveal this rare condition, whereas cardiac catheterisation with aortography remains the standard means of diagnosis.
ISSN:0340-6199
1432-1076
DOI:10.1007/s00431-005-1684-1