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