Waffle Procedure via Left Anterolateral Thoracotomy for a Tuberculous Constrictive Pericarditis Patient / 日本心臓血管外科学会雑誌

We present the case of a 72-year-old man with constrictive pericarditis due to tuberculous pericarditis, who was treated with the waffle procedure via left anterolateral thoracotomy. The preoperative catheterization study showed the dip-and-plateau pattern, and the echocardiographic study shown the thickened pericardium and dilatation impairment. The surgery was able to be performed without cardiopulmonary bypass. The thickened pericardium was abraded with a Harmonic Scalpel. The waffle procedure was effective in this patient. The postoperative course was good, with improvement of NYHA status and cardiac pressure study results. We suggest that this procedure is useful for the patients with constrictive pericarditis.

Tuberculosis pericárdica / Pericardial tuberculosis

La tuberculosis pericárdica es una presentación poco frecuente de infecciones causadas por especies de Micobacterias. Se presenta el caso de una paciente femenina de 43 años de edad con antecedentes de Leucemia linfocítica aguda en remisión completa, en fase de mantenimiento con Dasatinib durante cuatro años: había derrame pleural derecho como efecto secundario, y consultó por presentar disnea progresiva, concomitante fiebre de 39ºC precedida por escalofríos, sin patrón horario asociándose a las 72 horas exacerbación del patrón de disnea hasta la ortopnea y disminución del volumen urinario motivo por el cual es traída a nuestro centro. Durante su estancia hospitalaria se realiza TC de tórax hallándose de manera incidental la existencia de derrame pericárdico, se realiza ecoscopia donde se visualiza derrame pericárdico importante a predominio posterior, de 27 mm de volumen con colapso de cavidades cardíacas derechas, estableciéndose el diagnóstico de taponamiento cardíaco. Se realiza pericardiocentesis con obtención de 720 cc de liquido pericárdico turbio. 72 horas posterior al procedimiento presenta nuevo episodio de taponamiento cardíaco realizándose ventana pleuropericárdica; el ADA de líquido pericárdico reportó valores 2 veces superior a limite de corte; el resultado de la biopsia de pericardio reportó fibrosis pericárdica. En vista de hallazgos clínicos y paraclínicos se planteó el diagnóstico de Pericarditis tuberculosa.

Pleuropericardial tuberculosis is a rare presentation of infections caused by Micobacterias. The case of a 43 years - old female patient with a history of acute lymphocytic leukemia in complete remission in the maintenance phase with dasatinib for four years with right pleural effusion is presented. She consulted for progressive dyspnea; there was also fever (39ºC) and chills. Within 72 hours orthopnoea and decreased urine volume appeared. During her hospital stay a chest CT showed the existence of pericardial effusion, and endoscopy confirmed severe pericardial effusion of 27 mm with right-sided heart collaps, and because the diagnosis of cardiac taponade was made pericardiocentesis was performed, obtaining 720 cc of pericardial turbid fluid; after s 72 hours after a new episode of cardiac taponade occurred, so that a pleuropericardial window was done. ADA values reported 2 times higher cutting; pericardial biopsy reported pericardial fibrosis. In view of these findings, clinical and laboratory diagnosis of tuberculous pericarditis was established.

Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with Tuberculous Lymphadenitis

Purulent pericarditis is a rare condition with a high mortality rate. We report a case of purulent pericarditis subsequently caused by Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis in a previously healthy 17-year-old boy with mediastinal tuberculous lymphadenitis. The probable route of infection was a bronchomediastinal lymph node-pericardial fistula. The patient improved with antibiotic, antifungal, and antituberculous medication in addition to pericardiectomy.

Pericarditis tuberculosa / Tuberculous pericarditis

La tuberculosis sigue siendo una de las principales causas de morbilidad y mortalidad en el mundo. Su forma extrapulmonar representa hasta el 20 % de los casos. Se ha estimado que el compromiso pericárdico en esta enfermedad se presenta en 1 a 4 % de los pacientes diagnosticados. Su mortalidad alcanza el 90 % si no se diagnostica y se trata adecuadamente; este porcentaje se reduce a 12 % con el diagnóstico y el tratamiento oportunos. Se presenta el caso de una paciente de 55 años, hospitalizada durante dos semanas con síntomas constitucionales, fiebre intermitente, tos seca, dolor pleurítico y algunos síntomas de falla cardiaca. En los estudios de imaginología (radiografía y ecografía de tórax) se encontró derrame pleural bilateral de 300 ml en el lado derecho y de 1.000 ml en el izquierdo, así como derrame pericárdico de 500 ml. Las baciloscopias directas de los líquidos pleural y pericárdico, así como en esputo, fueron negativas, al igual que la proteína C reactiva (PCR); sin embargo, el cultivo del líquido pericárdico en medio de Löwenstein-Jensen fue positivo para Mycobacterium tuberculosis . El resultado de la prueba de PPD ( Purified Protein Derivative ) fue de 23 mm; una vez iniciado el tratamiento conjugado con isoniacida, rifampicina, etambutol y pirazinamida, se presentó una mejoría rápida del cuadro clínico que persistió hasta que se le dio de alta. La pericarditis tuberculosa puede considerarse como una manifestación infrecuente de la tuberculosis, con una morbilidad elevada y una mortalidad considerable, cuya probabilidad disminuye si hay un diagnóstico oportuno y se instaura un tratamiento efectivo temprano. Aunque se han sugerido varios criterios diagnósticos para la pericarditis tuberculosa, su diagnóstico definitivo puede implicar varios desafíos técnicos.

Tuberculosis remains a major cause of morbidity and mortality worldwide, and the extrapulmonary presentation represents up to 20% of this disease. The pericardial compromise of this disease has been estimated between 1% and 4% of diagnosed patients. This presentation may have a mortality rate as high as 90% without proper treatment and diagnosis, dropping to 12% with timely diagnosis and treatment. We present the case of a 55 year-old female patient hospitalized for two weeks with constitutional symptoms, intermittent fever, dry cough, pleuritic pain and some symptoms of heart failure. The imaging studies (chest x-rays and ultrasound), revealed bilateral pleural effusion: 300 cc on the right side, 1,000 cc on the left side, and 500 cc of pericardial effusion. Direct bacilloscopy of the pleural fluid, the pericardial fluid and the sputum were negative, as well as the C-reactive protein (CRP); however, the Löwenstein-Jensen culture of the pericardial fluid was positive for Mycobacterium tuberculosis . The result of the purified protein derivative (PPD) test showed a 23 mm swelling, and after quadruple therapy her clinical condition rapidly improved until final discharge. Tuberculous pericarditis can be considered as a rare manifestation of tuberculosis, with high morbidity and significant mortality which decrease with effective early diagnosis and treatment. Although several diagnostic criteria for tuberculous pericarditis have been suggested, a definitive diagnosis may suppose several technical challenges.

Tuberculosis extrapulmonar una patología subdiagnosticada: a propósito de un caso en el Centro Médico Boliviano Belga / Extrapulmonary tuberculosis a not diagnose pathology: a purpose of a case in the Centro Médico Boliviano Belga

En la actualidad la tuberculosis constituye un grave problema de salud pública con un resurgimiento a partir de la década 90. El pulmón es el órgano diana por excelencia de la tuberculosis, sin embargo cualquier otro órgano y sistema puede verse afectado y requieren del especialista, en ocasiones, su más valiosa pericia diagnóstica. El pericardio es uno de los sitios que menos invade el Mycobacterium tuberculosis, pero en los últimos años se reporta un incremento de su afectación en nuestro país, asociándose con una morbilidad y mortalidad significativa y frecuentemente asociada como causa de pericarditis constrictiva. Presentamos un paciente masculino de 62 años de edad, sin antecedentes patológicos conocidos, su cuadro clínico es de 1 semana de evolución caracterizado por dolor torácico de tipo opresivo, contínuo, 6/10 en la Escala Visual Analógica del dolor (EVA), con irradiación a región cervical, sin respuesta a analgésicos, disnea progresiva clase funcional II/IV según la clasificación de la New York Heart Association (NYHA) acompañado de astenia y adinamia; la radiografía de tórax con cardiomegalia, ECG sinusal, sin datos de isquemia, criterios de Framinghan para insuficiencia cardiaca ausentes. En su estadía hospitalaria presenta episodios de fibrilación auricular paroxística, precedida por palpitaciones, sin descompensación hemodinámica, por lo que se inicia tratamiento antiarrítmico, manteniendo la frecuencia cardiaca (FC) controlada; la terapéutica instaurada inicialmente en base a analgésicos e inhibidores de la bomba de protones sospechando una costo-condritis y/o Enfermedad por Reflujo Gastroesofágico (ERGE) tuvo poca respuesta; persistía el dolor torácico, se examina al paciente con mayor acuosidad encontrándose frote pericárdico trifásico por lo que se realiza un Ecocardiograma que reporta derrame pericárdico, se inicia tratamiento esteroidal y antiinflamatorio pensando en una pericarditis viral pero ante la persistencia de sintomatología a su cuarto día de hospitalización además de nuevos episodios de fibrilación auricular paroxística a pesar de antiarrítmico instaurado, descompensación hemodinámica y signos inminentes de taponamiento cardiaco se realiza una ventana pericárdica, se libera el pericardio tenso, drenando aproximadamente 400 cc de líquido pericárdico serohemático con bastante fibrina, la biopsia reporto una pericarditis fibrinosa crónica granulomatosa y un Adenosina Deaminasa (ADA) alto por lo que se inició tratamiento específico para tuberculosis y corticoides, con buena respuesta y resolución del cuadro.

Nowadays TB constitutes a serious public health problem with a revival beginning in the 90. The lung is the quint essential tuberculosis target organ, however any other organ and system can be affected and require specialist, on occasions, its most valuable diagnostic expertise. The pericardium is one of the places that least invades the Mycobacterium tuberculosis, but in recent years reported their involvement in our country increased, partnering with morbidity and significant and frequently associated mortality as a cause of constrictive pericarditis. We presenta male patient of 62 years of age, without a known pathological history, the clinical picture is 1 week of evolution characterized by chest pain of oppressive type, continuous, 6/10 on the scale of EVA, with irradiation to the cervical region, without response to pain medication, progressive dyspnea II/IV (NYHA) accompanied by fatigue and adynamia. X-ray of thorax with cardiomegaly, ECG sinus without data of ischemia, did not have Framinghan criteria for heart failure. In your hospital stay presents episodes of paroxysmal a trial fibrillation, preceded by palpitations, no hemodynamic decompensation, so it starts antiarrhythmic, maintaining the controlled FC; the therapeutic initially established based on pain relievers and inhibitors Proton pump suspecting a cost chondritis and/or GERD with little response. chest pain persisted, examined the patient with higher watery finding pericardial rub by what is Echocardiogram reported pericardial effusion 300 cc, starts treatment Steroidal and anti-inflammatory thinking in a viral pericarditis, but given the persistence of symptoms on their third day of hospitalization, new episodes of paroxysmal atrial fibrillation despite antiarrhythmic established, in addition to engorgement jugular bilateral 2/3, paradoxical pulse, hypotension and signs of imminent cardiac tamponade is a pericardial window, frees the pericardium tense, draining approximately 400 cc of pericardial fluid serohematico with enough fibrin, biopsy reported a fibrinous pericarditis chronic granulomatous and a high ADA so specific for tuberculosis treatment was started and corticoids with good response and resolution.

Interferon-gamma Release Assay Using Pericardial Fluid and Peripheral Blood for the Diagnosis of Tuberculous Pericarditis: A Case Report

Here, we report a case in which the rapid diagnosis of tuberculous pericarditis was made using Mycobacterium tuberculosis (MTB)-specific interferon-gamma release assay on peripheral blood and pericardial effusion. Acid-fast bacilli staining, mycobacterial culture, and nucleic acid amplification targeting MTB using pericardial fluid were negative. However, elevated adenosine deaminase (ADA) activity in pericardial fluid and interferon-gamma release assay positivity in both pericardial fluid and peripheral blood indicated the presence of tuberculous pericarditis. After anti-tuberculous and steroid treatment, the patient's clinical symptoms improved, and pericardial effusion has not reoccurred.

Pericarditis constrictiva tuberculosa: reporte de un caso y revisión de la literatura / Tuberculous constrictive pericarditis: case report and literature review

La pericarditis tuberculosa (PT) representa una rara manifestación extrapulmonar de tuberculosis (TBC), que se encuentra en aproximadamente el 1 por ciento de las autopsias por TBC y 1-2 por ciento de casos de TBC pulmonar, estando su presentación estrechamente asociado con la infección por VIH. El compromiso pericárdico ocurre habitualmente por diseminación linfática retrógrada o diseminación hematógena desde un foco pulmonar primario, pudiendo clínicamente manifestarse como derrame pericárdico, pericarditis constrictiva o un patrón mixto. El presente trabajo, describe los hallazgos clínicos y morfológicos de un caso de PT en un sujeto inmunocompetente de 78 años, con diagnóstico de PT constrictiva efectuado en el Hospital Hernán Henríquez Aravena de Temuco.

Tuberculous pericarditis (TP) is a rare manifestation of extrapulmonary tuberculosis (TBC), found in approximately 1 percent of autopsies by TB and 1-2 percent of cases of pulmonary TB, while his presentation closely associated with the HIV infection. The pericardial involvement usually occurs by retrograde lymphatic spread or hematogenous spread from a primary pulmonary focus, which may clinically manifest as pericardial effusion, constrictive pericarditis or a mixed pattern. This paper describes the clinical and morphological findings of a TP case in an 78-year old immunocompetent patient, with constrictive TP diagnosed made in the Hospital Hernán Henríquez Aravena in Temuco.

Type A Aortic Dissection during the Treatment of Tuberculous Pericarditis / 日本心臓血管外科学会雑誌

A 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase (72 IU/<i>l</i>). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.

The Ratio Between the Percentage of Lymphocytes and Glucose Levels in Pericardial Fluid as a Method to Diagnose Tuberculous Pericarditis / 대한내과학회지

BACKGROUND/AIMS: Adenosine deaminase (ADA) is a valuable biochemical marker for pericardial effusion (PE) and may be useful for diagnosing tuberculous pericarditis (TPE) in patients with PE. However, no definite cut-off or borderline values for ADA currently exist to distinguish TPE from other PE etiologies. In this study, we identified other useful parameters and characterized their relationship with ADA as a method for diagnosing TPE. METHODS: From June 2004 to November 2011, 42 patients underwent pericardiocentesis due to moderate or severe PE, as confirmed by echocardiography or chest computed tomography (CT). Patients were subdivided into TPE and non-TPE (NTPE) groups. We analyzed ADA (p) (the pericardial ADA) and %Lymph (p)/Glucose (p) (the ratio between the percentage of lymphocytes and glucose levels in PE). RESULTS: We defined the cut-off value of ADA (p) as 48.5 IU/L, and that of %Lymph (p)/Glucose (p) as 0.678%.dL/mg. In a multivariate logistic regression analysis, an odds ratio (OR) of 44.24 and a 95% confidence interval (CI) of 2.85-686.97 were observed in patients with an ADA (p) > or = 48.5 IU/L (p = 0.023). An OR of 20.39 and a 95% CI of 1.06-392.93 were observed in patients with a %Lymph (p)/Glucose (p) > or = 0.678%.dL/mg (p = 0.046). The combination of ADA (p) and %Lymph (p)/Glucose (p) had a higher positive predictive value (PPV, 80.0%) and specificity (Sp, 93.8%) than either ADA (p) (PPV, 47.4%; Sp, 68.8%) or %Lymph (p)/Glucose (p) (PPV, 69.2%; Sp, 87.5%) alone. CONCLUSIONS: %Lymph (p)/Glucose (p) is a useful parameter for distinguishing TPE from other pericardial diseases if combined with an ADA (p) > or = 48.5 IU/L.

Pericarditis tuberculosa: presentación de un caso y revisión de la literatura / Tuberculous pericarditis: a case report and review of the literature

La pericarditis constrictiva crónica es un síndrome clínico causado por la compresión cardíaca ejercida por un pericardio engrosado o rígido. La tuberculosis es una causa rara de pericarditis constrictiva en los países desarrollados. Sin embargo, ésta es una importante condición a considerar en países en desarrollo y en pacientes con infección por VIH. La pericarditis tuberculosa es una forma de tuberculosis extra-pulmonar que puede conducir a la muerte. La dificultad en su diagnóstico y las serias consecuencias de la infección no tratada hacen de esta condición un importante problema de salud tanto en países industrializados como en aquellos en vía de desarrollo. Ayudas diagnósticas como la ecocardiografía son esenciales en el diagnóstico, y ante la sospecha de afección tuberculosa del pericardio se indica la realización de estudios del líquido o del tejido pericárdico. El tratamiento antituberculoso se realiza durante seis meses y se considera la pericardiectomía en pacientes con pericarditis constrictiva calcificada o en quienes la constricción empeora después de seis a ocho semanas de tratamiento.

Constrictive pericarditis is a clinical syndrome caused by the cardiac compression of a thickened or rigid pericardium. Tuberculosis is a rare cause of constrictive pericarditis in developed countries. However, this is an important condition to consider in developing countries and in patients with HVI infection. Tuberculous pericarditis is a form of extra-pulmonary tuberculosis that may lead to death. The difficulty in its diagnosis and the serious consequences of this non-treated infection make this condition an important health problem both in industrialized and developing countries. Diagnostic aids such as echography are essential in the diagnosis, and in front of the suspicion of tuberculous infection of the pericardium, the performance of pericardial fluid or pericardial tissue studies is indicated. Anti TB treatment is carried out for six months and pericardiectomy is considered in patients with calcified constrictive pericarditis or in those in whom the constriction worsens after six to eight weeks of treatment.

A case of malignant pericardial mesothelioma misdiagnosed as tuberculosis pericarditis / 대한내과학회지

Primary pericardial mesothelioma is an extremely rare neoplasm with a bleak prognosis. It is often misdiagnosed as constrictive pericarditis initially, especially as tuberculosis pericarditis in Korea due to the high incidence of active tuberculosis. A targeted pericardial biopsy and noninvasive imaging modalities, such as delayed phase contrast chest computed tomography (CT) images and magnetic resonance imaging (MRI), can play an important role in the differential diagnosis of pericardial disease. We present the case of a 37-year-old man with a 3-week history of exertional dyspnea. A large pericardial effusion with pericardial thickening was noted, but its etiology was not revealed after conventional diagnostic procedures, including a closed pericardial biopsy. Empirical antituberculosis treatment was started, but the dyspnea recurred 5 months later. A malignant pericardial mesothelioma was diagnosed through a pericardiectomy and biopsy under direct visualization

The Application of Tubercular Antibody Assay in the Diagnosis of Tuberculous Pericarditis / 医学研究杂志

Objective To explore the value of tubercular antibody (TBAb) in the diagnosis of tuberculous pericarditis (TBP).Methods The TBAb in 38 patients were determined by colloidal gold (CG) and compared with 64 healthy control. Results The positive ratio in TBP group was significantly higher as compared with control group. The hydropericardium was significantly decreased or disappeared after 6 months of antituberculotic treatment by color Doppler ultrasonography. It seemed that patients were rehabilitated and electrocardiogram (ECG) was normal. Conclusion TBAb is valuable in the diagnosis,differential diagnosis or treatment of TBP.

A case of tuberculous pericarditis presenting as pericardial mass compressing pulmonary artery / 대한내과학회지

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.

A case of tuberculous pericarditis presenting as pericardial mass compressing pulmonary artery / 대한내과학회지

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.

A Cases of Tuberculous Pericarditis Associated with Pseudoaneurysm of the Left Ventricle

The incidence of left ventricular pseudoaneurysm is not known, but it appears to be quite rare. We experienced a case of apical pseudoaneurysm of left ventricle in a 73-year-old female who presented with progressive orthopnea. On the 2nd hospital day, cardiac tamponade developed. A small pseudoaneurysm of left ventricle with narrow neck associated with massive pericardial effusion was demonstrated by transthoracic echocardiography. Emergency coronary angiogram showed normal. Emergency operation was performed on the suspicion of rupture of the pseudoaneurysm. Microscopic examination of the wall of the aneurysm revealed fibrous tissue adhered to the granulomatous inflammatory pericardium.