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; 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.


CONCLUSIONS
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.
Piastra
Marco
M
Paediatric Intensive Care Unit, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy. xoct01@yahoo.it
Polidori
Giancarlo
G
De Carolis
Maria Pia
MP
Tempera
Alessia
A
Caresta
Elena
E
Pulitanò
Silvia
S
Chiaretti
Antonio
A
Valentini
Piero
P
De Rosa
Gabriella
G
D001027:Aortography; D001990:Bronchiolitis, Viral / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006328:Cardiac Catheterization; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004452:Echocardiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012770:Shock, Cardiogenic / Q000209:etiology