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A 9 year old boy presented to A&E following a respiratory arrest which occurred after a prolonged period of coughing. He was hypoxic with sats of 60% despite bagging in 100% oxygen, bradycardic at 60 bpm, deeply unconscious and had a severe mixed acidosis. Initial resuscitation included: intubation and ventilation, IV access and fluid boluses, inotropes and broad spectrum antibiotics. Examination was unremarkable besides poor air entry bibasally and prominent finger clubbing.

Massive pericardial effusion secondary to undiagnosed severe hypothyroidism in a child with neurodisability