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Clin. Cardiol. 24, 415 (2001)

Images in Cardiology

This section edited by Edward A. Geiser, M.D.

Chronic Tuberculous Pericarditis Causing Constrictive Pericarditis

Brenda Hott, M.D., and Wendy M. Book, M.D.

Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

A 37-year-old male presented with signs and symptoms of congestive heart failure. Physical examination was remarkable for marked elevation of the jugular neck veins and hepatomegaly. Assessment by echocardiography revealed normal systolic function. Reciprocal filling of the ventricles with respiratory variation of mitral inflow suggested constrictive pericarditis.

Cardiac catheterization confirmed constrictive physiology with equalization of diastolic pressures. Left and right ventricular diastolic pressures were found equal at 20 mmHg. Cardiac magnetic resonance imaging demonstrated marked pericardial thickening and bilateral pleural effusions (Fig. 1). The patient underwent successful pericardectomy with relief of symptoms. Pathology showed pericardial fibrosis with multiple caseating granulomas (Fig. 2). Classic "cording" of the Mycobacterium tuberculosis isolated from the pericardial cultures is shown in Figure 3.

Fig. 1 Axial views of the chest (magnetic resonance imaging). There are bilateral pleural effusions and marked thickening of the pericardium (arrows).
Fig. 2 Pathology specimen demonstrating caseating granulomas in the pericardium (arrow).
Fig. 3 Classic "cording" of Mycobacterium tuberculosis cultured from the pericardium.

Reference

  1. Mehta A: Constrictive pericarditis. Clin Cardiol 1999;22:334–344

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