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A case report of tuberculous constrictive pericarditis necessitating total pericardiectomy

Nooraldaem Yousif1, Abdulla Alnuwakhtha1, Abdulla Darwish2

  • 1Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre (MKCC), Awali, Kingdom of Bahrain.

European Heart Journal. Case Reports
|November 5, 2021
PubMed

Insights

Tuberculous constrictive pericarditis (CP) poses diagnostic challenges. A novel hemodynamic assessment approach aided early diagnosis, leading to successful surgical intervention and symptom resolution.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Constrictive pericarditis (CP) is a severe complication of tuberculous pericarditis, causing heart constriction due to inflammation and thickening.
  • Accurate diagnosis and prompt intervention are vital for managing CP, presenting significant clinical challenges.

Observation:

  • A case study of a Bahraini male with tuberculous lymphadenitis diagnosed with CP.
  • Echocardiography showed suboptimal acoustic windows, and CT revealed no significant pericardial calcification.
  • Hemodynamic assessment via right antecubital vein and right radial artery provided a novel diagnostic approach.

Findings:

  • The patient underwent successful total pericardiectomy, revealing a thickened, stiff pericardium with abscesses and adhesions.
  • Pericardial biopsy confirmed large caseating granulomas, indicative of tuberculosis.
  • The patient experienced complete resolution of heart failure symptoms post-surgery.

Implications:

  • This case highlights the difficulties in diagnosing CP, especially with suboptimal imaging.
  • Early diagnosis and timely surgical intervention, like pericardiectomy, are crucial for favorable outcomes in CP.
  • Novel hemodynamic assessment techniques can aid in diagnosing challenging CP cases.
Abstract

Keywords:
Antecubital veinCase reportConstrictive pericarditisPericardiectomyRight heart studySwan-ganz catheterTuberculosis

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