Prompt diagnosis and therapy are keys to reducing mortality -- Extrapulmonary tuberculosis, part 5: Pericardial involvement

• Published in: The Journal of respiratory diseases Vol. 28; no. 7; p. 278
• Main Author: Ahluwalia, Gautam
• Format: Journal Article
• Language: English
• Published: Darien CMP Medica, LLC 01.07.2007; MultiMedia Healthcare Inc
• Subjects: Care and treatment; Diagnosis; Patient outcomes; Pulmonary tuberculosis; United States
• ISSN: 0194-259X

Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease-effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282) More often, patients present with some form of chronic pericarditis, such as chronic pericardial effusion, cardiac tamponade, chronic constrictive pericarditis, or effusive-constrictive pericarditis. Usually, chronic pericarditis represents the typical progression of the disease, which eventually occurs in most patients when diagnosis and treatment are delayed. However, some patients with pericardial tuberculosis present initially with sequelae of chronic constrictive pericarditis without having gone through an initial stage of pericardial effusion. On abdominal examination, the presence of ascites is disproportionate to the edema (ascites praecox) and congestive splenomegaly is evident. The abdominal findings in patients with constrictive pericarditis resemble those in patients with cirrhosis. However, an elevated JVP distinguishes patients in the former group from those with cirrhosis, in whom the JVP is not elevated. Patients with chronic constrictive tuberculous pericarditis also manifest signs of a protein-losing enteropathy, which results in hypoalbuminemia. Untreated chronic constrictive pericarditis can give rise to cardiac cirrhosis with associated myocardial atrophy. Patients with chronic constrictive pericarditis have a very poor prognosis after pericardiectomy.10,11