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.

Tuberculous pericarditis and the cardiac conduction system.

Nine cases of acute and 8 cases of chronic tuberculous pericarditis were studied for involvement of epicardial structures such as the S-A node, A-V node and large coronary arteries. Extensive caseation was seen in the region of the S-A node in 2 cases of chronic and one case of acute pericarditis. No nodal tissue was identifiable in these cases. In one more case of chronic pericarditis, granuloma with fibrosis was seen in the S-A node. Minor mononuclear infiltration of the S-A node was seen in 2 cases. In the rest of the cases, the S-A node was normal though inflammation was very close to it in 4 cases of acute and all the cases of chronic pericarditis. The A-V node, bundle of His and coronary arteries were normal in these cases.

A biopsia no diagnóstico do comprometimento pericárdico por tumores malignos / The biopsy in the diagnosis of pericardial involvement by malignant tumors

Doze pacientes (oito mulheres, quatro homens) com quadro clínico de tamponamento cardíaco (nove pacientes - 75%) ou congestäo venosa sistêmica com derrame pericárdico importante ao ecocardiograma (três pacientes - 25%) foram submetidos a microtoracotomia subxifóidea para realizaçäo de biopsia pericárdica na tentativa de caracterizaçäo do processo etiológico. Cinco pacientes (41%) apresentaram biopsia compatível com comprometimento tumoral maligno metastático, sendo que nos outros sete (59%) a biopsia mostrou apenas pericardite crônica inespecífica; nestes, o diagnóstico etiológico foi obtido por outros métodos. Concluímos que a biopsia é um método seguro, de alta especificidade, porém de baixa sensibilidade no diagnóstico do conmprometimento neoplásico maligno do pericárdio