Expansile lake of translucency in pericardial effusion. A manifestation of left ventricle to pericardial fistula from rupture of tuberculosis myocardial abscess

A 12 year old boy was admitted to a District hospital with history of abdominal pain, and persistent vomiting of several days duration. Exploratory laparotomy was done and terminal small intestine appearances were suggestive of ileocaecal tuberculosis. During post operative course he was found to have large bilateral pleural effusions on chest x-ray. Subsequently his general condition deteriorated and he was then shifted to tertiary care hospital where chest intubation was done. Echocardiography revealed large pericardial effusion with tamponade which was drained with a pigtail catheter, kept in situ for intermittent drainage. Clinical workup and investigations were consistent with disseminated tuberculosis for which anti-tuberculosis treatment was started. A month later, echocardiography was repeated for removal of pigtail catheter which revealed lake of translucency within the small residual pericardial fluid which was expansile with cardiac cycle. This was further evaluated with colour and colour M-mode. [Panel A,B,C,D]. Findings were suggestive of fistulous communication between left ventricular cavity and pericardial space secondary to tuberculous myocardial abscess rupture confirmed on histopathology post-operatively. What lends novelty to this case is that this serious but apparently innocuous looking finding could easily have been overlooked in a casual examination

Pseudoaneurysm of right ventricle due to localized tuberculosis of myocardium: a case report

A 5-year-old girl was admitted to the hospital with chest pain, fever and dyspnea. Physical examination showed normal heart sounds, diminished pulmonary sounds in the left hemithorax and a normal ECG. On chest X-ray the heart was slightly enlarged with moderate left pleural effusion. CT scan revealed pleural effusion and a hypodense mass at the apex of the heart. A cystic mass was detected by echocardiography as well. The patient was operated as a case of hydatid cyst of the right ventricle. Intraoperatively a pseudoaneurysm of the right ventricle was found. The mass centrally consisted of clots and necrotic tissue and peripherally was composed of fibrosis and calcification. All of these tissues were removed and the communication between the aneurysm and right ventricle was repaired. The diagnosis of tuberculosis was confirmed by culture and microscopic examination. The patient underwent anti- TB treatment for 6 months and remained symptom-free after 4 years. It is believed that local expansion of tuberculous adenitis near the pericardium has caused a TB abscess, which in turn affected the myocardium and destroyed it

Pericarditis tuberculosa en el Hospital Cayetano Heredia: estudio retrospectivo 1969 - 1990 / Tuberculous pericarditis in Hospital Cayetano Heredia: retrospective study 1969 - 1990

Se revisaron las Historias Clínicas de 53 pacientes con pericarditis tuberculosa en el Hospital Cayetano Heredia entre 1969 y 1990. Los criterios de inclusión fueron: BK positivo en Líquido pericárdico (n igual 4), biopsia pericárdica compatible (n igual 3), TBC activa en otro órgano (n igual 27) y PPD mayor de 10mm con exclusión de otras etiologías y buena respuesta al tratamiento antiTBC (n igual 19). El 66 por ciento fueron varones. La población joven se afectó con mayor frecuencia (más del 50 por ciento entre 10 y 39a). La presentación más frecuente fue en las formas agudas y crónica. En la mayoría de casos hubo localización extrapericárdica de la TBC. La pericardiocentesis fue inocua. El líquido pericárdico fue con mayor frecuencia un exudado sanguinolento. El ecocardiograma fue útil en la detección y cuantificación del derrame pericárdico. 20 pacientes recibieron sólo tratamiento antituberculoso, 29 recibieron además esteroides y 4 fueron pericardiectomizados. Sólo 2 pacientes fallecieron (3.7 por ciento). 37 pacientes tuvieron seguimiento con un promedio de 35.2 meses, encontrándose sólo 2 sintomáticos en su último control

Tuberculose miocárdica: relato de um caso e revisäo da literatura / Myocardial tuberculosis: report of a case and review of the literature

O acometimento cardíaco na tuberculose é pouco freqüente devido a uma provável resistência natural do miocárdio a infecçäo pelo Mycobacterium tuberculosis. Säo descritas quatro formas de doença no coraçäo: nodular, difusa infiltrativa e miocardite intesticial inespecífica. As vias de contaminaçäo do miocárdio säo a disseminaçäo hematogênica, a drenagem linfática retrógrada a partir de linfonodos mediastinais contaminados e a infecçäo por contiguidade direta com o pericárdio. A ausência de sintomatologia clínica específica e a dificuldade na identificaçäo de bacilos álcool-resistentes tornam dificil o diagnóstico clínico, contribuindo para a evoluçäo desfavorável na maioria dos casos. Os autores apresentam um caso de tuberculose do miocárdio com acometimento valvar, em doente jovem do sexo feminino tratada cirurgicamente e atualmente no sexto mês de acompanhamento