1. TUBERCULOUS CONSTRICTIVE PERICARDITIS
MEDIC
TUBERCULOUS CONSTRICTIVE PERICARDITIS
NGUYEN XUAN TRINH, MD
Department of Cardiology, MEDIC

2. 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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Chest X-Ray

6. Lab Test
MEDIC

7. 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, (1999)

8. CARDIAC CTA
MEDIC

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CARDIAC CTA

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CARDIAC CTA

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CARDIAC CTA

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CARDIAC CTA

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CARDIAC CTA

14. CARDIAC CTA
MEDIC

15. Preoperative Diagnosis
MEDIC
Preoperative Diagnosis
1. CONSTRICTIVE PERICARDITIS
2. RIGHT PLEURAL EFFUSION

16. Surgical resection- HCM Heart Institute
MEDIC
Surgical resection- HCM Heart Institute

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Surgical resection

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Surgical resection

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Histopathology

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Postoperative: Happy and follow-up treatment at Pham Ngoc Thach Hospital

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DISCUSSION

22. 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

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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

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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

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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

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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

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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 P

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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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THANKS
FOR
YOUR ATTENTION