Subacute tuberculous constrictive pericarditis

Abstract

A 22-year-old man was admitted to the hospital with progressively worsening exertional dyspnea, thoracic pain, and low-grade evening fever. Transthoracic echocardiography revealed a thick fibrinous exudate in the pericardial sac (A) associated with diminished movements of the heart surface and septal bouncing ( B , Online Videos 1 and 2 ). An exaggerated inspiratory expansion of the right ventricle and simultaneous compression of the left ventricle were noticed ( Online Video 3 ). Doppler echocardiography reported large respiratory variations in ventricular filling and aortic flow (C, D) . Also, increased suprahepatic vein flow reversal with expiration was detected (E) . Cardiac magnetic resonance was performed and showed generalized pericardial thickening involving both parietal and visceral pericardium, with maximal thickness of 20 mm (F) . Contrast-enhanced imaging showed prominent delayed hyperenhancement at the pericardium (G) . The patient had strongly positive tuberculin test results, and a biopsy of a mediastinal adenopathy was performed. Histopathologic examination showed severe inflammation with granulomas, consistent with tuberculosis (H) .