Tuberculous Pericarditis-Own Experiences and Recent Recommendations

Abstract

Tuberculous pericarditis (TBP) accounts for 1% of all forms of tuberculosis and for 1-2% of extrapulmonary tuberculosis. In endemic regions, TBP accounts for 50-90% of effusive pericarditis; in non-endemic, it only accounts for 4%. In the absence of prompt and effective treatment, TBP can lead to very serious sequelae, such as cardiac tamponade, constrictive pericarditis, and death. Early diagnosis of TBP is a cornerstone of effective treatment. The present article summarises the authors' own experiences and highlights the current status of knowledge concerning the diagnostic and therapeutic algorithm of TBP. Special attention is drawn to new, emerging molecular methods used for confirmation of M. tuberculosis infection as a cause of pericarditis.

Keywords: constrictive pericarditis; extrapulmonary tuberculosis; pericarditis; tuberculous pericarditis.

Figure 1

Chest radiograph in supine position shows significantly enlarged cardiac silhouette, signs of pulmonary congestion, and increased homogeneous density superimposed over the lungs due to bilateral pleural effusion.

Figure 2

Chest CT scan with contrast enhancement: mediastinal window (a,b) and lung window (c,d) revealed large pericardial effusion up to 4 cm thick (a,b, asterisk), with no significant pericardial thickening, and SVC and IVC dilatation. A small amount of pleural fluid was also demonstrated. Additionally, several small nodules were seen in the apex of the right lung (c,d, arrows).

Figure 2

Chest CT scan with contrast enhancement: mediastinal window (a,b) and lung window (c,d) revealed large pericardial effusion up to 4 cm thick (a,b, asterisk), with no significant pericardial thickening, and SVC and IVC dilatation. A small amount of pleural fluid was also demonstrated. Additionally, several small nodules were seen in the apex of the right lung (c,d, arrows).