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for massive pericarditis causing compromise of cardiac output, or if significant
symptoms persist despite therapy with NSAIDs. In the presence of tamponade or
progressive deterioration, pericardiocentesis provides temporary relief, whereas antiinflammatory medications are used to prevent re-accumulation of fluid.
Pulmonary Emergencies. Pleural effusions are a recognized manifestation of sJIA (
Fig. 101.9 ). Occasionally, pleural fluid collections may be massive, resulting in
respiratory distress. Other pleuropulmonary complications include pneumonitis, diffuse
interstitial disease, lymphoid bronchiolitis, and pulmonary arteritis. In the absence of
the need for thoracentesis for diagnostic or therapeutic purposes, treatment is aimed at
the underlying disease process, primarily involving control of inflammation with
NSAIDs, corticosteroids, or anakinra. Children with pleural effusions often require
admission in order to address the overall severity of systemic features of the disease.

FIGURE 101.9 Pericardial and pleural effusions in a child with systemic onset juvenile idiopathic
arthritis.