ABSTRACT
In sub-Saharan Africa, pericardial tuberculosis is frequently diagnosed in HIV sero-positive patients. Myocardial involvement has only rarely been reported. We present an HIV sero-positive patient in whom both pericardial and myocardial tuberculosis were diagnosed, and highlight the value of cardiac magnetic resonance imaging in the diagnosis and management of this condition.
Subject(s)
Antitubercular Agents/therapeutic use , Cardiomyopathies/pathology , HIV Seropositivity/complications , Magnetic Resonance Imaging , Pericarditis, Tuberculous/pathology , Tuberculosis, Cardiovascular/pathology , Adult , Cardiomyopathies/complications , Cardiomyopathies/drug therapy , Cardiomyopathies/microbiology , Female , Humans , Pericarditis, Tuberculous/complications , Pericarditis, Tuberculous/drug therapy , Treatment Outcome , Tuberculosis, Cardiovascular/complications , Tuberculosis, Cardiovascular/drug therapyABSTRACT
Infection with Mycobacterium tuberculosis and the human immunodeficiency virus has reached epidemic proportions in South Africa. Cardiac involvement occurs in approximately one per cent of patients suffering from active tuberculosis. This concerns predominantly pericardial involvement, resulting in chronic pericardial effusions, cardiac tamponade and constrictive pericarditis. Effusive-constrictive pericarditis is a clinical haemodynamic syndrome in which constriction by the visceral pericardium occurs in the presence of a tense effusion in a free pericardial space. We present a patient who was diagnosed with this condition, and highlight the value of contrast-enhanced magnetic resonance imaging in demonstrating the underlying structural and functional abnormalities.
Subject(s)
HIV Seropositivity/complications , Magnetic Resonance Imaging , Pericardial Effusion/pathology , Pericarditis, Constrictive/pathology , Pericarditis, Tuberculous/pathology , Adult , Antitubercular Agents/therapeutic use , Echocardiography, Doppler , Electrocardiography , Humans , Male , Pericardial Effusion/drug therapy , Pericardial Effusion/microbiology , Pericarditis, Constrictive/drug therapy , Pericarditis, Constrictive/microbiology , Pericarditis, Tuberculous/complications , Pericarditis, Tuberculous/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Much of the morbidity associated with deep-vein thrombosis (DVT) is absent from the evidence base used to define best clinical practice. Intravenous (IV) drug use is an increasingly frequent cause of DVT. AIM: To obtain a profile of DVT patients in routine clinical care, and determine the contribution of IV drug use. DESIGN: Retrospective case-note review. METHODS: We reviewed 232 episodes of lower-limb DVT in a large district general hospital during 1996. RESULTS: Patients had mean (range) age 62.8 (21-97) years, with 43.9% aged > 70 years. A large proportion would have been excluded from prospective studies that have contributed to current DVT guidelines. Risk factors included smoking (33.0%), immobility (26.5%), previous DVT (23.6%), surgery in the last 3 months (18.2%), malignancy (16.5%), varicose veins (10.5%) and IV drug use (6.9%). Forty-five (19.4%) had multiple risk factors. Postsurgical DVT commonly presented from the community following initial hospital discharge. Intravenous drug use accounted for 48.4% of episodes in patients aged < or =40 years. Thrombosis was right-sided in 68.8% of IV drug users, compared to 38.2% in others (p = 0.034). DISCUSSION: Our patients differed from those in most of the prospective studies used to develop routine clinical care pathways for DVT. Intravenous drug use is an important cause of community-acquired DVT in young adults.
