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Case Reports
. 2019 May;47(5):2262-2268.
doi: 10.1177/0300060519834454. Epub 2019 Mar 21.

Tuberculous pericarditis mimicking multiple tumors in pericardial effusion

Caie Li  1 , Qiming Zhao  2 , Xiangyang Wu  3 , Jing Yu  4
Affiliations
Case Reports

Tuberculous pericarditis mimicking multiple tumors in pericardial effusion

Caie Li et al. J Int Med Res. 2019 May.

Abstract

Tuberculosis is still the leading cause of pericardial disease in developing nations. A definite diagnosis of tuberculosis is usually relatively difficult, especially when its manifestations are not typical. We report a 19-year-old man who presented with chest obstruction, shortness of breath, edema of the lower extremities, and mild fever for 14 days. The manifestations of tuberculosis pneumonia were not typical, except for a small high-density shadow in the left upper lung field near the pleura, with a small amount of pleural effusion on chest computed tomography. The tuberculin skin test, acid-fast stain of sputum and pericardial effusion, and bacterial culture showed negative results. Echocardiography showed three free-floating irregular masses in a large amount of pericardial effusion. The masses and exudates were removed by pericardiectomy. The masses were composed of hyperplastic granulation tissue and dead tissue without a normal architecture, mixed with numerous caseous substances, which confirmed the diagnosis of tuberculous pericarditis. This is a unique report of a patient who presented with tuberculous pericarditis with multiple solid masses in a large amount of pericardial effusion, without typical clinical manifestations of tuberculosis.

Keywords: Tuberculosis; cardiac tamponade; caseous granuloma; fever; pericarditis; pneumonia.

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Figures

Figure 1.
Figure 1.
Computed tomographic scan of the chest. A small high-density shadow in the left upper lung field near the pleura in a lung window image and a large amount of pericardial effusion with a small amount of pleural effusion in a mediastinal window image can be seen.
Figure 2.
Figure 2.
Echocardiographic finding on admission. Free-floating irregular masses in a large amount of pericardial effusion can be seen.
Figure 3.
Figure 3.
Echocardiographic finding before pericardiectomy. Irregular masses with pericardial effusion persisted.
Figure 4.
Figure 4.
One of the masses in the pericardial space. The tissue is yellowish, soft, and fragile.
Figure 5.
Figure 5.
Microscopic finding. Hyperplastic granulation tissue and dead tissue without a normal architecture, mixed with numerous caseous substances.
See this image and copyright information in PMC

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