Introduction Chronic granulomatous disease of childhood (CGD) is a rare congenital abnormality of phagocytic function first described by Berendes et al. in 1957 [1]. The X- linked form of the disease accounts for up to 66% of cases; hence boys are predominantly affected. CGD is now known to be a group of genetic disorders each af- fecting a particular component of the reduced nicotina- mide adenine dinucleotide phosphate (NADPH) oxidase system. The disease is characterised by the in- ability of phagocytic cells to kill catalase-positive bacte- ria and fungi and results in recurrent suppurative infections primarily involving the skin, lymph nodes, lungs, liver, bones and gut. Granulomatous reaction to infection is typical. Improved understanding and man- agement of the disease have considerably reduced the early mortality. Pericardial involvement is very rare. We present two children with known CGD and pericar- dial effusions in whom no microbial cause for the effu- sions was found. Case reports Patient 1 A 10 and 1/2-month-old boy, in whom the diagnosis of CGD had been made postnatally, was admitted with a history of fever, cough and difficulty in breathing. He had been unwell for the previous 10 days, and his family practitioner had diagnosed possible ear in- fection and prescribed amoxycillin. There had been no real clinical improvement. On examination, he was febrile, tachypnoeic and tachycardic. He had a maculopapular rash on his skin, unremarkable abdominal examination and no signs of dehydration. The throat was normal and his ears could not be examined because of wax. Some wheez- ing was noted at the right lung base. Haematological investigations revealed: haemoglobin 9.9 g dl ±1 , white-cell count 13.9  10 9 l ±1 , neutrophils 6.2  10 9 l ±1 , lymphocytes 6.7  10 9 l ±1 and platelets 571  10 3 . Urea, electrolytes, clotting and liver-function tests were normal. The provisional diagnosis was lower respiratory tract infection, and a chest X-ray was obtained which showed an enlarged cardiac shadow with a possible mediastinal mass (Fig. la). There appeared to be some AP compression of the trachea on a lateral radiograph (Fig. 1 b). There were no signs of lung consolidation. CT was unsuc- Filipe Macedo Kieran McHugh David Goldblatt Pericardial effusions in two boys with chronic granulomatous disease Received: 6 October 1998 Accepted: 10 May 1999 F. Macedo Department of Radiology, Hospital Geral de Santo Antonio, Porto, Portugal F. Macedo, K. McHugh ( ) ) Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK D. Goldblatt Department of Immunology, Great Ormond Street Hospital for Children, London, UK Abstract Pericardial involvement in chronic granulomatous disease (CGD) is very rare. We present two children with known CGD and peri- cardial effusions in whom no micro- bial cause for the effusions was found. Pediatr Radiol (1999) 29: 820±822 Ó Springer-Verlag 1999