A Case of Acute Tuberculous Pericarditis with Transient Constrictive Pericarditis for a Short Time

(Department of Cardiothoracic Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan and The Second Department of Surgery, Tokyo Medical University*, Tokyo, Japan)

Hiromi Yano Tatsuhiko Kudou Naoki Konagai
Mitsunori Maeda Masaharu Misaka Masataka Matsumoto
Shin Ishimaru*
A 32-year-old man was admitted with dyspnea on exertion and a prolonged common cold. Swelling of mediastinal lymph nodes, pericardial thickening and pleural effusion were detected by chest CT. Mycobacterial culture of sputa and pleural effusion were negative. Serum adenosine deaminase (ADA) activity was normal. A tuberculin test showed a positive reaction (20~15mm). Viral antibody titers (Coxsackie A9, echo 3, influenza B) were negative. Ten days after admission, the patient had pyrexia and low cardiac output symptoms. Right ventricular pressure curve cardiac catherterization showed a gdip and plateauh pattern which indicated constrictive pericarditis. We performed subtotal pericardiectomy (from the right phrenic nerve to the left phrenic nerve). Pathological examination of pericardium showed Langerhans' giant cell infiltration and caseous necrosis which could be diagnosed as tuberculosis. Although the patient had transient pleural effusion, symptoms disappeared postoperatively. At present there are no signs of recurrent infection.
@Jpn. J. Cardiovasc. Surg. 30: 193-196 (2001)