TUBERCULOUS CONSTRICTIVE PERICARDITIS MEDIC TUBERCULOUS CONSTRICTIVE PERICARDITIS NGUYEN XUAN TRINH, MD Department of Cardiology, MEDIC
Case Report 25 M Job: Supermarket Staff MEDIC Case Report 25 M Job: Supermarket Staff Chief Complaint: fatigue, dyspnea, leg edema for the past 2 weeks Bloat Jugular Vein (+). Past medical history: No problems Echocardiography , Abdominal Ultrasound Chest X-Ray Lab test
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MEDIC Chest X-Ray
Lab Test MEDIC
Normal Pericardial Thickness : < 2mm CARDIAC CTA-Normal Pericarium MEDIC Normal Pericardial Thickness : < 2mm J. P. Delille et al. Maximal thickness of the normal human pericardium assessed by electron-beam computed tomography. Eur. Radiol. 9, 1183-1189 (1999)
CARDIAC CTA MEDIC
MEDIC CARDIAC CTA
MEDIC CARDIAC CTA
MEDIC CARDIAC CTA
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MEDIC CARDIAC CTA
CARDIAC CTA MEDIC
Preoperative Diagnosis MEDIC Preoperative Diagnosis 1. CONSTRICTIVE PERICARDITIS 2. RIGHT PLEURAL EFFUSION
Surgical resection- HCM Heart Institute MEDIC Surgical resection- HCM Heart Institute
MEDIC Surgical resection
MEDIC Surgical resection
MEDIC Histopathology
MEDIC Postoperative: Happy and follow-up treatment at Pham Ngoc Thach Hospital
MEDIC DISCUSSION
Tuberculous pericarditis(TBP) MEDIC Tuberculous pericarditis(TBP) Rare but particularly severe complication, Mortality of 80–90% when not handled properly and 12– 17% with appropriate treatment . TB is responsible for about: 4% of cases of acute pericarditis, 7% of cases of cardiac tamponade 6% of cases of constrictive pericarditis. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242
MEDIC In a few underdeveloped countries, TB is the leading cause of pericarditis . TBP incidence in developed countries is only 4% of all cases of TB but in some areas of South Africa, TBP represented 69.5% of pericarditis that required pericardial puncture for diagnosis . In sub-Saharan Africa, the incidence of TBP is increasing due to the HIV epidemic, and this trend is likely to occur in other parts of the world due to HIV infection. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242
MEDIC Tuberculous pericarditis diagnosis is difficult to establish in the absence of personal or family history suggesting a TB infection history or contact with another person with TB. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242
MEDIC Although paraclinical methods of investigation such as classical radiology, CT, MRI, cytological exams, microbiological and even histopathology, it is sometimes difficult to specify the etiology of pericarditis. According to studies, tuberculous pericarditis constitutes to around 1–2% of all cases of pulmonary TB autopsied without clinically diagnosis Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242
MEDIC PCR method to detect the presence of tuberculous bacilli in the pericardial fluid, which has directed the etiological diagnosis. PCR positive value in the diagnosis of pericardial tuberculosis: PCR gave positive results in 80% of cases; other studies have shown that the PCR method is less sensitive than other methods, often giving false positive results Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242
MEDIC Management Constrictive pericarditis has a progressive but variable course. For most patients,surgical pericardiectomy is the definitive treatment. Martin M. Constrictive pericarditis . Braunwald Heart Disease 2019. P 1672-1675
MEDIC CONCLUSION TBP is a rare disease, hard to diagnose in the absence of a known contact with a pulmonary TB contact. Laboratory examination, such as chest radiography, CT, MRI and cardiac echography suggest the diagnosis; however, the certainty of tuberculous etiology is confirmed by evidentiating the Mycobacterium tuberculosis in the pericardic liquid or on histopathology slides. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242
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