| A 23 year old army man presented with progressive dyspnoea and was found to have a massive pericardial effusion. Despite extensive investigations the cause remained elusive, until samples were sent for polymerase chain reaction (PCR). This case was unusual for several reasons and is a reminder of the atypical way in which tuberculosis infection can present and how a high index of suspicion should be maintained. It shows the importance of molecular biological advances in providing simple and rapid methods for arriving at the correct diagnosis, by way of nucleic acid probes and polymerase chain reaction. ( info) |
| In this case study, pericarditis results from mycobacterium tuberculosis and mycobacterium fortuitum. Both organisms were isolated from three different clinical specimens: a pericardial fluid, pericardium, and a thoracentesis fluid. A mixed mycobacterial culture was initially suspected upon examining Ziehl-Neelsen stained smears prepared from the primary cultures following seven to ten days of incubation. Dilutions and subcultures were subsequently performed, confirming the presence of two different organisms. ( info) |
3/55. Fibrinofibrous pericarditis mimicking a pericardial tumor. Primary pericardial disease is rare in children. The clinical features usually reflect limited venous return and cardiac output. Tuberculous pericarditis is the leading cause of pericardial disease in developing nations. A definitive diagnosis in children is frequently difficult and the manifestations are protean. We report a 10-month-old girl with fibrinofibrous pericarditis that manifested as constrictive pericarditis with prolonged fever, hepatomegaly, edema, and poor appetite. echocardiography showed a solid mass that originated from the thickened pericardium and compressed the whole heart. In contrast, computed tomography revealed pericardial thickening with fluid collection. The symptoms and signs dramatically improved after surgical pericardiectomy. Pathologic analysis confirmed the diagnosis of tuberculous fibrinofibrous pericarditis. The patient received a 1-year course of antituberculosis therapy and has remained symptom free for 2 years. We suggest that a discrepancy between echocardiography and computed tomography (CT) findings might indicate a diagnosis of fibrinofibrous pericarditis. ( info) |
4/55. myocarditis and pericarditis with tamponade associated with disseminated tuberculosis. Tuberculous involvement of the myocardium is relatively rare. Tuberculous pericarditis with tamponade and myocarditis in a young woman with no evidence of immunosuppression and disseminated tuberculosis is described. Three distinct forms of myocardial involvement are recognized: nodular tubercles (tuberculomas) of the myocardium; miliary tubercles of the myocardium; and an uncommon diffuse infiltrative type. The myocardium is involved by a hematogenous route, by lymphatic spread or contiguously from the pericardium. The diagnosis can be made by endomyocardial biopsy if clinical suspicion is strong and echocardiographic findings are suggestive. Antituberculosis drugs may be curative. With an increasing prevalence of tuberculosis, the possibility of potentially lethal myocardial tuberculosis is important to consider. ( info) |
| A 34-year-old man developed severe heart failure due to constrictive pericarditis. pericardiectomy was carried on and the patient died 12 hours after surgery. Necropsy revealed an extensive hemorrhagic myocardial infarction involving the lateral free wall of the left ventricle in the absence of coronary artery disease. In addition, necropsy revealed tuberculosis as the etiology of constrictive pericarditis. Thus, myocardial infarction may occur in constrictive pericarditis in the setting of pericardiectomy and absence of coronary artery disease. ( info) |
6/55. cardiac tamponade as a manifestation of tuberculosis. Tuberculosis has been increasing in incidence in recent years. Pericardial involvement and pericardial effusions are well-documented and may result in pericardial tamponade. Despite this, large pericardial effusions are uncommon, and manifestation as cardiac tamponade is rare. We report two cases of tuberculous pericarditis in which the initial feature was tamponade. Since the diagnosis of tuberculosis may be delayed due to the slow-growing nature of the bacterium, physicians need to be aware of this possibility and consider the use of modern diagnostic techniques that may permit an earlier diagnosis. ( info) |
7/55. Constrictive tuberculous pericarditis in a hiv-positive patient. Constrictive pericarditis is a relatively rare clinical manifestation nowadays. We present the case of an hiv-positive patient with constrictive calcified pericarditis due to an infection with mycobacterium tuberculosis. Pericardectomy was performed. The therapeutical approach is discussed and the literature is reviewed. ( info) |
8/55. Coexistence of tuberculous constrictive pericarditis and right atrial tuberculoma: a case report. Tuberculous constrictive pericarditis is a rare condition with a high mortality rate. The coexistence of constrictive pericarditis and intracardiac tuberculoma has not previously been reported. We report the case of a 65-year-old man presenting with left-side pleural effusion and signs of systemic venous congestion for 2 months. echocardiography and computerized tomography showed a thickened pericardium and a mass in the right atrium. pericardiectomy and excision of the right atrial mass were performed. Pathologic examination of the pericardium and the right atrial mass both revealed chronic granulomatous inflammation with acid-fast bacilli and confirmed the diagnosis of tuberculous constrictive pericarditis and right atrial tuberculoma. This case reminds us of the possibility of this type of rare combination of tuberculous constrictive pericarditis and intracardiac right atrial tuberculoma, and the need for complete imaging studies when such cases are encountered. ( info) |
9/55. Tuberculous pericarditis: optimal diagnosis and management. pericarditis is a rare manifestation of tuberculous disease. The appropriate diagnostic workup and optimal therapeutic management are not well defined. We present 10 new cases of tuberculous pericarditis and review the relevant literature. The specific topics addressed are (1) the importance of tissue for diagnosis, (2) the optimal surgical management, (3) the role of corticosteroids, and (4) the impact of human immunodeficiency virus (hiv) on the management of this disease. The cases and the literature suggest that the optimal management includes an open pericardial window with biopsy, both for diagnosis and to prevent reaccumulation of fluid. Corticosteroids probably offer some benefit in preventing fluid reaccumulation as well. The data are inconclusive regarding whether open drainage or corticosteroid use prevents progression to constrictive pericarditis. No studies have addressed these issues specifically in hiv-positive patients, but the 3 hiv-positive patients in our series had an excellent response to drainage and antituberculous therapy. ( info) |
10/55. Detection of mycobacterium tuberculosis complex dna in pericardial fluid, bone marrow and peripheral blood in a patient with pericardial tuberculosis. A case report. Definitive diagnosis of tuberculous pericarditis requires identification of bacilli in pericardial fluid or tissue. Conventional diagnostic methods are time-consuming and have a low sensitivity making bacteriological confirmation of the disease very difficult. Hereby, we report the case of molecular detection of mycobacterium tuberculosis in pericardial fluid, bone marrow and peripheral blood from a 63-year-old woman with pericardial tuberculosis, using a nested PCR assay specific for IS6110 insertion element of M. tuberculosis complex. The patient had an excellent response to a three-drug combination anti-tuberculous regimen and 1 year later was asymptomatic, without evidence of constrictive pericarditis. ( info) |