ABSTRACT

Farmer of 38 years sent to Emergency Department by dyspnea of small efforts of 6 months of evolution, accompanied by increase of the abdominal diameter, edema of pelvic members, unquantified ponderal loss and pericardial effusion of 450 mL. Diagnostic paracentesis a lymphocytic exudate with adenosin deaminasa (ADA) of 35 U, transthoracic echocardiography that demonstrates constrictive pericarditis with serious diastolic dysfunction, calcium hyper-refringence and patch deposits in pericardium, thoracoabdominal CT scan shows bilateral pleural effusion, pericardic thickening › 10 mm and ascitis. The patient go to Pericardiectomy and surgeon’s observed extensive fibrosis of pericardium (Concretio cordis) and the pleuropericardic biopsy shows cheesy granulomas confirming the diagnosis of poliserositis and constrictive pericarditis of tuberculous origin. Iniciated treatment with antituberculous drugs and systemic steroid and repeats echocardiogram to the 30 days showing improvement in the diastolic function as well as decrease of the pericardic inflammation and the systolic pressure of the pulmonary artery.

KEYWORDS

Tuberculous pericarditis, constrictive pericarditis, poliserositis, pericardial effusion, diastolic dysfunction, Concretio cordis, congestive heart failure, urgent pericardiectomy, .

REFERENCES

1. Strang JIG, Nunn AJ, et al. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei: results at 10 years follow-up. Q J Med 2004; 97: 525-535.

2. Cherian G. Diagnosing of tuberculous a etiology in pericardial effusion. Postgrad Med Journal 2004; 80: 262-266.

3. Mayosi BM, Burguess LJ, et al. Tuberculous pericarditis. Circulation 2005; 112: 3608-3616.

4. Reuter H, Burguess LJ, et al. Adenosine deaminase activity – more than a diagnostic tool in tuberculous pericarditis. Cardiovascular Journal of South Africa 2005: 16(3).

5. Reuter H, Burguess L, et al. Diagnosing tuberculous pericarditis. Q J Med 2006; 99: 827-839.

6. Cinar B, Enc Y, et al. Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy. Int J Tuberc Lung 2006; 10(6): 701–706.

7. Lazarus AA, Thilagar B. Tuberculosis of pericardium, larynx, and other uncommon sites. Dis Mon 2007; 53: 46-54.