Histoplasma associated pericarditis with pericardial tamponade in a child.

Histoplasma-mediated pericarditis is rare, and it occurs due to host-mediated inflammatory or immune response to adjacent mediastinal adenitis or pneumonitis. It is usually self-limited and rarely progresses to a disseminated infection in an immunocompetent individual. In rare instances, it can occur without pulmonary manifestations, making the diagnosis challenging given the broad list of differentials that can be considered as in our patient who initially presented with an isolated pericardial effusion with tamponade needing emergent pericardiocentesis.

Coin Aspiration Presenting as Chronic Cough and Tracheoesophageal Fistula.

Chronic cough can be a diagnostic challenge in the pediatric population. Foreign body aspiration without typical signs and symptoms can often be overlooked as a cause of chronic cough in children. Coin aspirations in the trachea typically have a sagittal orientation on an anteroposterior (AP) chest radiograph. We report a rare case of a previously healthy five-year-old girl presenting with a chronic cough for five months caused by a coin with a coronal orientation on an AP chest radiograph. The coin, initially presumed to be lodged in the esophagus, was actually lodged in the cervical trachea, leading to the development of a tracheoesophageal fistula (TEF). Her AP chest radiograph showed a coronal, circular radio-opaque shadow and the lateral view a tangential radio-opaque shadow, prompting an initial evaluation by esophagogastroduodenoscopy, which was normal. She then underwent rigid bronchoscopy, revealing a coin lodged in the trachea along with a TEF. Surgical removal was achieved through an external approach with a vertical tracheotomy and insertion of a tracheostomy tube. Five days later, a repeat rigid bronchoscopy showed a well-healed TEF, and she was successfully decannulated. She was ultimately discharged home on room air and oral feeds. TEF as a complication of a foreign body lodged in the trachea or esophagus is rare but life-threatening. Foreign body aspiration should always be considered in the differential diagnosis when evaluating younger children with chronic cough.