Two-dimensional speckle strain imaging: in the management of paraganglioma, acute junctional tachycardia, and myocardial dysfunction in a child

Two-dimensional speckle-tracking strain imaging (speckle strain imaging) is useful for evaluating left ventricular myocardial function in patients with ischemic heart disease and cardiomyopathy, including hypertrophic and dilated phenotypes. The usefulness of speckle strain imaging in patients with pheochromocytoma who are undergoing adrenal surgery has been described, but we found no reports of the use of this method to evaluate ventricular dysfunction longitudinally in children. Herein, we describe the case of a 10-year-old girl with a paraganglioma, acute junctional tachycardia, and myocardial dysfunction. After control of the tachycardia and partial resection of the tumor, speckle strain imaging enabled clinical management that led to substantial improvement in the patient's initially diffuse myocardial dysfunction. Because conventional echocardiographic methods alone may be inadequate to guide the management of pediatric patients with partially resected neuroendocrine tumors, we recommend speckle strain imaging as an additional noninvasive option for treatment guidance and monitoring of cardiac tissue response.