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363 ISOLATED TUBERCULOUS PERICARDITIS IN A YOUNG HEALTY WOMAN
  1. C. Chin,
  2. S. Huerta,
  3. A. Abolhoda,
  4. J. C. Milliken
  1. Irvine, Department of Surgery

Abstract

Background Tuberculous pericarditis (TBP) is a rare clinical entity but carries a high mortality rate (20%-40%). The incidence of TBP among patients with pulmonary TB ranges from 1%-8%. Pericardial involvement is invariably associated with TB elsewhere in the body by infectious extension in the lung, tracheobronchial tree, adjacent lymph nodes, spine, sternum, or by miliary spread. In many adults, TBP represents reactivation disease, making the primary focus of infection less apparent. Symptoms of TBP are related to either fluid overload (i.e. pulmonary and peripheral edema) compromised cardiac output (i.e. fatigue and dyspnea) or both. Physical exam has low yield in the diagnosis, but may demonstrate symptoms of volume overload and compromised cardiac output. ECG and CXR may be suggestive of the diagnosis, but ECHO is currently the gold standard modality for constrictive pericarditis. Treatment of TBP is largely medical. Pericardiectomy is reserved for patients with recurrent effusions or failed medical management.

Methods In the present report, we discuss a healthy 44-year-old Vietnamese woman, who first presented with fever, cough productive of yellow sputum, shortness of breath, and pleuritic chest pain for 9 months. She then underwent extensive work-up and evaluation for persistence and worsening fluid overload and pump failure symptoms. ECHO revealed constrictive pericarditis. Thus, the patient was taken to the operating room for a pericardiectomy.

Results Following surgical intervention, our patient had a rapid and marked clinical improvement. Biopsy of the pericardial tissue revealed caseating granulomas with acid-fast bacilli.

Conclusion Isolated TBP is a rare clinical entity but its diagnosis and prompt management may result in decreased morbidity and mortality. Treatment remains largely medical, but surgical intervention is indicated in those patients with worsening symptoms.

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