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