Cardiac Tamponade; A rare Presentation of Childhood Hypothyroidism

Myxedema heart disease is a well known entity. pericardial effusions have been reported in 50-73% of pediatric patients with hypothyroidism in various series, but none of these describes the symptomatic pericardial effusions or cardiac tamponade. 5 year female child presented with complaints of periorbital puffiness and mild abdominal distension intermittently for last 6 months. she was symptomatically treated with diuretics off and on without much benefit. this time she reported to pediatric emergency with progressively increasing respiratory distress for last 5 days. there was no history of any fever, decreased urine output, orthopnea, or koch’s contact.