Internalizing symptoms and functional disability in children with noncardiac chest pain and innocent heart murmurs.

OBJECTIVE: To examine the occurrence of internalizing symptoms and functional disability in children with noncardiac chest pain (NCCP) compared with children with innocent heart murmurs (IHMs). METHOD: 67 children with NCCP (M [SD] age = 12.61 [2.63]; 68.7% Caucasian) and 62 children with IHM (M [SD] age = 12.67 [2.62]; 50% Caucasian) were recruited from pediatric cardiology offices. Children and parents completed measures of psychological functioning and functional disability during a first visit to the cardiologist before diagnosis. RESULTS: Children with NCCP reported greater levels of anxiety, depression, and anxiety sensitivity than children with IHM. Children with NCCP and their parents reported greater levels of functional disability and somatization than children with IHM and their parents. CONCLUSION: Children with NCCP experience greater levels of psychosocial distress and impairment than similarly physically healthy children with IHM. Consideration of psychosocial influences on NCCP would likely be beneficial in aiding assessment and treatment.

Health care utilization and psychosocial factors in pediatric noncardiac chest pain.

OBJECTIVE: This study investigated factors related to health care utilization (HCU) among patients presenting to pediatric cardiologists with symptoms of chest pain later diagnosed as noncardiac chest pain (NCCP). METHODS: Participants included 67 children and adolescents diagnosed with NCCP and their parent. Measures of HCU, pain severity, and child self-report and parent self-report of anxiety and depression were collected at the cardiologist's office. The child's sex was examined as a moderator of HCU. RESULTS: Pain severity and maternal and child depression were significant contributors to the variance in child HCU. The relationship between depression and HCU was moderated by the child's sex, with boys higher in levels of maternal or child depression reporting greater HCU. CONCLUSIONS: Psychological factors are related to HCU for children with NCCP, with depression positively associated with HCU. The child's sex plays an important role in depression and HCU. Family-focused psychological screening of pediatric patients with NCCP may aid in identifying families who may benefit from referrals for psychological assessment and treatment.

Brief report: Psychosocial factors and pediatric noncardiac chest pain.

OBJECTIVE: To investigate the associations between children's perceived chest pain severity, somatization symptoms, depressive symptoms, anxiety sensitivity, and maternal somatization symptoms in children and adolescents with noncardiac chest pain (NCCP). METHODS: Measures of chest pain and psychosocial functioning were collected from 35 participants (M age = 12.5 years, 54% female) with NCCP and their parents during evaluation at cardiology clinics. RESULTS: Among children presenting for cardiac evaluations, wide variation in ranges of pain severity, episode frequency, and history were observed. Children's somatic symptoms and fear of physiological arousal predicted significant variance in children's chest pain severity. Additionally, children's depressive symptoms and maternal somatization were both significant predictors of children's somatic symptoms. CONCLUSIONS: These results suggest NCCP may be part of a broader pattern of somatic responding and sensitivity to physiological arousal. This pattern is associated with both child and maternal functioning. Suggestions for future research are provided.

Kimura's disease: case report and review of the literature.

Kimura's disease is a rare, chronic inflammatory disease characterized by subcutaneous nodules in the head and neck regions associated with regional cervical lymphadenopathy. Following its recognition as a pathologic entity, numerous reports have been published detailing the pathogenesis, radiologic manifestations, and treatment modalities. An extensive review of the literature did not reveal any cases of diffuse thoraco-abdominal lymphadenopathy described in relation to Kimura's disease. Hence, the interest in the case discussed here.

Pericardial effusion and tamponade in infants with central catheters.

OBJECTIVE: To describe the clinical presentation, cause, and outcome of central venous catheter (CVC)-related pericardial effusions (PCE) in infants. METHODS: A retrospective case review was conducted of CVC-related PCE at university and private neonatal intensive care units. Data from our cases were combined with published case reports and included clinical presentation and outcome; biochemical evaluation of pericardial fluid; days until diagnosis; cardiothoracic ratios; and CVC characteristics, insertion site, and tip placement site. RESULTS: In our cases, 6 different neonatology groups cared for 14 patients at 6 different hospitals in 2 cities. These data were combined with 47 cases reviewed from the literature. Pericardial fluid was obtained in 54 cases from the combined group and was described qualitatively as consistent with the infusate in 53 of 54 cases (98%). Biochemical analysis was performed in 37 cases, and in 36 of 37 cases (97%), the pericardial fluid was consistent with the infusate. The median gestational age at birth was 30.0 weeks (range: 23.5-42). The median time from CVC insertion to diagnosis was 3.0 days (range: 0.2-37; n = 59). Sudden cardiac collapse was reported in 37 cases (61%), and unexplained cardiorespiratory instability was reported in 22 cases (36%). The CVC tip was last reported within the pericardial reflections on chest radiograph in 56 cases (92%) at the time of PCE diagnosis. The mean cardiothoracic ratio increased 17% (n = 14). No patients died among our cases. Among the reviewed cases, 45% mortality was reported. For the combined group, mortality was 34%. For the combined group, mortality was 8% (3 of 37) in the patients who underwent pericardiocentesis versus 75% (18 of 24) for the patients who did not. In 21 patients, the catheter was withdrawn and remained in use. Survivors and nonsurvivors had comparable gestational age at birth, birth weight, days to PCE diagnosis, and day of life of PCE symptoms/diagnosis. Access site, catheter type, and catheter size were not associated with mortality. An association between larger catheters and shorter time to PCE may be present. Access site and catheter type were not associated with time to PCE. Autopsy specimens reported 6 cases of myocardial necrosis/thrombus formation, 9 cases of perforation without myocardial necrosis/thrombus formation, and 2 cases in which both were reported. CONCLUSIONS: The pericardial fluid found in CVC-associated PCE is consistent with the infusate. We speculate that there are several mechanisms, ranging from frank perforation that seals spontaneously to CVC tip adhesion to the myocardium with diffusion into the pericardial space. Routine radiography should be performed, and the CVC tip should be readily identifiable. The CVC tip should remain outside the cardiac silhouette but still within the vena cavae (approximately 1 cm outside the cardiac silhouette in premature infants and 2 cm in term infants). A change in cardiothoracic ratio may be diagnostic of a PCE, and pericardiocentesis is associated with significantly reduced mortality. Increased awareness of this complication may decrease the mortality associated with CVC-related PCE.