Tuberculous pericardial effusion

Case contributed by Dr Ammar Ashraf

Presentation

Shortness of breath, fever, and cough for 10 days. No chest pain, palpitations, or weight loss.

Patient Data

Age: 45 years
Gender: Male
X-ray

Enlarged cardiac shadow with a water bottle configuration, suggestive of pericardial effusion. Small left pleural effusion with left basal atelectatic changes.  

Status post pericardiocentesis; a pericardial drain is seen in place.

Mildly thickened & enhancing pericardium with mild residual pericardial effusion is noted. Multiple enlarged necrotic mediastinal lymph nodes, suspicious of an infectious etiology, such as tuberculosis (TB) are noted; other possibilities include metastasis from an unknown primary. Mild bilateral pleural effusions with consolidation/partial collapse in the underlying lower lobes. A few scattered atelectatic bands are also seen in both lungs.

X-ray

Follow up chest x-rays

Gradual interval improvement is noted in the enlarged cardiac shadow/pericardial effusion on chest radiographs taken after one and three weeks of initiation of anti-tuberculous treatment. 

Case Discussion

  • Urgent echocardiogram was done in the emergency department which showed a large pericardial effusion.
  • Therapeutic pericardiocentesis was done (1.2 liter yellow color pericardial fluid was aspirated). 
  • Laboratory analysis of the pericardial fluid was positive for mycobacterium tuberculosis complex & acid fast bacilli (AFB) and negative for malignant cells.
  • Sputum was negative for acid fast bacilli. 
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Case information

rID: 80957
Published: 11th Aug 2020
Last edited: 14th Aug 2020
System: Chest, Cardiac
Inclusion in quiz mode: Included
Institution: Ministry of national guard health affairs

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