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Case Reports
. 2015 Sep 7;4(4):e29614.
doi: 10.5812/cardiovascmed.29614. eCollection 2015 Nov.

Tuberculous Constrictive Pericarditis

Gary Tse  1 , Aamir Ali  2 , Francisco Alpendurada  2 , Sanjay Prasad  2 , Claire E Raphael  1 , Vassilis Vassiliou  2
Affiliations
Case Reports

Tuberculous Constrictive Pericarditis

Gary Tse et al. Res Cardiovasc Med. .

Abstract

Introduction: Constrictive pericarditis is characterized by constriction of the heart secondary to pericardial inflammation. Cardiovascular magnetic resonance (CMR) imaging is useful imaging modality for addressing the challenges of confirming this diagnosis. It can be used to exclude other causes of right heart failure, such as pulmonary hypertension or myocardial infarction, determine whether the pericardium is causing constriction and differentiate it from restrictive cardiomyopathy, which also causes impaired cardiac filling.

Case presentation: A 77-year-old man from a country with high incidence of tuberculosis presented with severe dyspnea. Echocardiography revealed a small left ventricle with normal systolic and mildly impaired diastolic function. Left heart catheterization revealed non-obstructive coronary disease, not felt contributory to the dyspnea. Anatomy imaging with cardiovascular magnetic resonance imaging (CMR) showed global, severely thickened pericardium. Short tau inversion recovery (STIR) sequences for detection of oedema/ inflammation showed increased signal intensity and free breathing sequences confirmed septal flattening on inspiration. Late gadolinium imaging confirmed enhancement in the pericardium, with all findings suggestive of pericardial inflammation and constriction.

Conclusions: CMR with STIR sequences, free breathing sequences and late gadolinium imaging can prove extremely useful for diagnosing constrictive pericarditis.

Keywords: Constrictive Pericarditides; Pericardial Effusion; Tuberculosis.

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Figures

Figure 1.
Figure 1.. Cardiovascular Magnetic Resonance Imaging
A, Demonstrating significant bilateral pleural effusion and pericardial thickening (13 mm). B, Short tau inversion recovery sequences (fat suppression) showing increased pericardial edema, suggestive of inflammation. C, Delayed gadolinium enhancement was observed ion the pericardium, in keeping with pericardial inflammation. These images are consistent with constrictive pericarditis with a tuberculous origin later confirmed by histology.
See this image and copyright information in PMC

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