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

Tuberculous aortitis

Tuberculous aortitis [TA] is a rare entity that is invariably indicative of disseminated tuberculosis. TA is associated with aneurysm formation in about half of cases. Another possible complication is perforation of adjacent structures [1-7]. Both abdominal and thoracic aorta are involved with equal frequency.[7-9] Fatal outcomes are frequently reported even after antituberculosis chemotherapy and surgical intervention. We present a case of tuberculous aortic aneurysm [TBAA] that underwent surgical resection and graft replacement in the bed of the infected aorta. Following an apparently successful chemotherapy, the patient died suddenly. We postulate that reactivation of the un-eradicated bacilli precipitated graft failure. Similar cases in the literature are reviewed. We propose lifelong suppressive therapy with antituberculosis agents to prevent such a catastrophic event

Tuberculosis of the renal artery.

A young female who underwent nephrectomy for renovascular hypertension was diagnosed on histology to have tuberculosis of the renal artery. This was an isolated finding as there was no tuberculous infection elsewhere including tissues in the vicinity of the vessels. A survey of literature did not yield any reports of tuberculous renal arteritis, making this the first such case.

Thalamic haemorrhage due to tuberculous arteritis.

A young adult presenting as subarachnoid haemorrhage, which was proved to be a thalamic haemorrhage on CT scan, with evidence of tuberculous arteritis, is reported.