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.

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.

Angiosarcoma del corazón y su ruptura espontánea. Rara causa de pericarditis efusivo-constrictiva. Presentación de un caso y revisión de la literatura / Angiosarcoma of the heart and its spontaneous rupture. A rare cause of effusive-constrictive pericarditis. A case report and review of the literature

The authors present the clinical history of a male 44 year old patient who was hospitalized with the diagnosis of pericardial constriction and effusion and operated on as an emergency because of spontaneous cardiac rupture and was found to have a cardiac adenosarcoma. They review the literature in order to discuss a very rare cause of hemopericardium and constrictive pericarditis with epidemiologic, diagnostic, therapeutic and prognostic commentaries and secondly, to try to establish if this type case does not represent a diagnostic problem for the ecocardiographer since an angiosarcoma that occupies the pericardial space can be confused with a hemopericardium. They also mention other imaging studies that are used to better characterize and diagnose these tumors

Endomyocardial biopsy: its diagnostic usefulness.

In order to assess the diagnostic usefulness of EMB in patients with clinically suspected myocardial diseases, with and without heart failure or dysrhythmias, a prospective study was carried out in 84 consecutive patients. With EMB, the histological diagnosis was considered specific in 33 patients (39.3%), confirmative in 12 patients (14.3%) and negative in 39 patients (46.4%). It was found particularly useful in patients with unexplained heart failure and idiopathic dysrhythmias and in the differentiation between restrictive cardiomyopathy and constrictive pericarditis. The procedure can be safely performed with minimal morbidity and there was no mortality in the present study.