Tuberculous pericardial calcifications

Case contributed by Doralice Ferreira

Presentation

Past medical history of tuberculosis (TB) treated in 2013, presenting with cough, fatigue and one episode of hemoptysis. Chest x-ray evaluation for recurrent tuberculosis.

Patient Data

Age: 50 years
Gender: Male

No new focal pneumonia, effusion or pneumothorax. Mild diffuse bilateral peribronchial thickening.

Stable right upper lobe scarring with adjacent pleural thickening/reaction consistent with history of tuberculosis. No evidence of active TB.

The heart remains normal sized without pulmonary vascular congestion.

Almost diffuse curvilinear/circumferential pericardial calcification.

No acute osseous findings.

Case Discussion

Tuberculous pericarditis is frequently reported as the primary cause of pericardial calcification 1 and occurs in approximately 1 to 2 percent of patients with pulmonary tuberculosis (TB). This is a rare finding in the Western World. However, tuberculous pericarditis accounts for nearly 10% of chronic constrictive pericarditis cases in the United States 2. There is strong evidence that large calcific pericardial deposits indicate “burnt-out” pericardial tuberculosis 2. Detecting the pericardial calcification on radiography is important for definitive diagnosis 2.

The differential diagnosis for pericardial calcifications include 1:

  • idiopathic
  • viral
  • TB
  • trauma
  • cardiac surgery
  • radiation
  • connective tissue disorders
  • malignancy

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center   

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Case information

rID: 59772
Published: 27th Apr 2018
Last edited: 12th Apr 2020
System: Chest, Cardiac
Inclusion in quiz mode: Included
Institution: OVMC

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