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Armored Heart Because of Tuberculous Constrictive Pericarditis

2019; Lippincott Williams & Wilkins; Volume: 12; Issue: 3 Linguagem: Inglês

10.1161/circimaging.118.008726

1942-0080

Takafumi Uchi, Daihiko Hakuno, Tomoaki Fukae, Masashi Takahashi, Shunichi Takiguchi, Hui-Chong Li, Kenya Nishizawa, Hiroyuki Nozaki, Koichiro Sueyoshi,

Infectious Diseases and Tuberculosis

HomeCirculation: Cardiovascular ImagingVol. 12, No. 3Armored Heart Because of Tuberculous Constrictive Pericarditis Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessCase ReportPDF/EPUBArmored Heart Because of Tuberculous Constrictive Pericarditis Takafumi Uchi, MD, Daihiko Hakuno, MD, PhD, Tomoaki Fukae, MD, Masashi Takahashi, MD, PhD, Shunichi Takiguchi, MD, PhD, Hui-Chong Li, MD, Kenya Nishizawa, MD, PhD, Hiroyuki Nozaki, MD, PhD and Koichiro Sueyoshi, MD, PhD Takafumi UchiTakafumi Uchi Department of Internal Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (T.U., H.N.) , Daihiko HakunoDaihiko Hakuno Daihiko Hakuno, MD, PhD, Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawa St, Kawasaki-ku, Kawasaki City, Kanagawa, 210-0013, Japan. Email E-mail Address: [email protected] Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (D.H., M.T., S.T., H.-C.L., K.N., K.S.) , Tomoaki FukaeTomoaki Fukae Department of Internal Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (T.F.) , Masashi TakahashiMasashi Takahashi Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (D.H., M.T., S.T., H.-C.L., K.N., K.S.) , Shunichi TakiguchiShunichi Takiguchi Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (D.H., M.T., S.T., H.-C.L., K.N., K.S.) , Hui-Chong LiHui-Chong Li Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (D.H., M.T., S.T., H.-C.L., K.N., K.S.) , Kenya NishizawaKenya Nishizawa Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (D.H., M.T., S.T., H.-C.L., K.N., K.S.) , Hiroyuki NozakiHiroyuki Nozaki Department of Internal Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (T.U., H.N.) and Koichiro SueyoshiKoichiro Sueyoshi Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan (D.H., M.T., S.T., H.-C.L., K.N., K.S.) Originally published26 Feb 2019https://doi.org/10.1161/CIRCIMAGING.118.008726Circulation: Cardiovascular Imaging. 2019;12:e008726A 72-year-old man with a history of diabetes mellitus, hypertension, and dyslipidemia was admitted to our hospital because of fever, dyspnea, and an infiltrative shadow in the right upper lobe of the lungs on chest X-ray. Results of blood examination showed elevated CRP (C-reactive protein) level (10.8 mg/dL) on admission. Left bundle branch block, mild left ventricular (LV) systolic dysfunction, and a minimal amount of pericardial effusion were present on ECG and transthoracic echocardiography, respectively. Coronary angiography showed normal results. Fever, abnormal pulmonary shadow, and CRP levels partially normalized with intravenous antibiotic treatment, and he was discharged from the hospital.After 50 days, he was readmitted because of pleural effusion. At that time, we detected massive dense pericardial effusion, pericardial thickening, and severe LV systolic dysfunction by transthoracic echocardiography (arrows in Figure [A] and Movie I in the Data Supplement). Cardiac magnetic resonance imaging revealed a 19 mm thickened pericardium with high signals in the inside by T2-weighted black blood image (arrows in Figure [B]) and on the peripheral surface by late gadolinium enhancement (arrows in Figure [C]), indicating inflammation in the fibrotic pericardium because of constrictive pericarditis. Cardiac catheterization revealed elevation in mean right atrium pressure (13 mm Hg), steep Y descent in right atrium pressure, equalization of end-diastolic pressures between right ventricle and LV (13 mm Hg and 18 mm Hg, respectively), and dip and plateau pattern in right ventricle pressure, which support the diagnosis. On the contrary, endomyocardial biopsy did not show any granulomatous inflammation. Systemic contrast computed tomography showed no malignancy, whereas sputum and pleural effusion cultures detected Mycobacterium tuberculosis; hence, the patient was diagnosed with tuberculous constrictive pericarditis.Download figureDownload PowerPointFigure. Armored Heart Because of Tuberculous Constrictive Pericarditis.A–C, Transthoracic echocardiography (A) parasternal short-axis view, T2-weighted black blood image (B) and late gadolinium enhancement (C) of cardiac MRI showing inflammatory pericardial effusion in the thickened fibrotic pericardium before tuberculosis treatment. D–F, Transthoracic echocardiography (D) apical 4-chamber view, T2-weighted image (E), and late gadolinium enhancement (F) of cardiac MRI 7 months after treatment. LA indicates left atrium; LV, left ventricle; and RV, right ventricle;.Triple anti-tuberculosis drugs (isoniazid, rifampicin, and ethambutol hydrochloride) and 60 mg/d of oral prednisolone were started. Seven months later, echocardiography (Figure [D] and Movie II in the Data Supplement) and cardiac magnetic resonance imaging (Figure [E] and [F]) revealed no pleural effusion and improved pericardial thickening, but the capsulated mass was increased in size (56×62×21 mm) outside the anterolateral wall of the LV, mildly pressing against it.Once tuberculous pericarditis develops, it carries a high mortality rate of 14% to 40%, and >50% of which cases progress to constrictive pericarditis.1 Adjunctive corticosteroid therapy reduces the incidence of constrictive pericarditis, but it does not significantly affect overall mortality or cardiac tamponade requiring pericardiocentesis.2,3 American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America recently recommended that initial adjunctive corticosteroid therapy should not be routinely used in patients with tuberculous pericarditis, but might be appropriate in selective, highest risk patients such as with large pericardial effusion or with early signs of constriction.4 In this case, careful follow-up and consideration of timely surgery of the mass outside the LV are needed.DisclosuresNone.FootnotesThe Data Supplement is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.118.008726.Current address for Dr Uchi: Department of Neurology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama City, Kanagawa, 230-0012, Japan.Daihiko Hakuno, MD, PhD, Department of Cardiovascular Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawa St, Kawasaki-ku, Kawasaki City, Kanagawa, 210-0013, Japan. Email [email protected]comReferences1. Larrieu AJ, Tyers GF, Williams EH, Derrick JR. Recent experience with tuberculous pericarditis.Ann Thorac Surg. 1980; 29:464–468.CrossrefMedlineGoogle Scholar2. Mayosi BM, Ntsekhe M, Bosch J, Pandie S, Jung H, Gumedze F, Pogue J, Thabane L, Smieja M, Francis V, Joldersma L, Thomas KM, Thomas B, Awotedu AA, Magula NP, Naidoo DP, Damasceno A, Chitsa Banda A, Brown B, Manga P, Kirenga B, Mondo C, Mntla P, Tsitsi JM, Peters F, Essop MR, Russell JB, Hakim J, Matenga J, Barasa AF, Sani MU, Olunuga T, Ogah O, Ansa V, Aje A, Danbauchi S, Ojji D, Yusuf S; IMPI Trial Investigators. Prednisolone and Mycobacterium indicus pranii in tuberculous pericarditis.N Engl J Med. 2014; 371:1121–1130. doi: 10.1056/NEJMoa1407380CrossrefMedlineGoogle Scholar3. George IA, Thomas B, Sadhu JS. Systematic review and meta-analysis of adjunctive corticosteroids in the treatment of tuberculous pericarditis.Int J Tuberc Lung Dis. 2018; 22:551–556. doi: 10.5588/ijtld.17.0341CrossrefMedlineGoogle Scholar4. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, Chaisson LH, Chaisson RE, Daley CL, Grzemska M, Higashi JM, Ho CS, Hopewell PC, Keshavjee SA, Lienhardt C, Menzies R, Merrifield C, Narita M, O'Brien R, Peloquin CA, Raftery A, Saukkonen J, Schaaf HS, Sotgiu G, Starke JR, Migliori GB, Vernon A. Executive summary: official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis.Clin Infect Dis. 2016; 63:853–867. doi: 10.1093/cid/ciw566CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Shao Y, Yang Z, Yin L, Wang Q, Wang J and Dong Z (2022) The Clinical Efficacy of Cedilanid and Isosorbide Dinitrate plus Pericardial Dissection for Chronic Constrictive Pericarditis in the Elderly and Its Influence on Plasma Endothelin, Atrial Natriuretic Peptide, and Systemic Immune-Inflammation Index, Evidence-Based Complementary and Alternative Medicine, 10.1155/2022/5406649, 2022, (1-7), Online publication date: 22-Jun-2022. Nishizawa T, Ro S, Asano T and Tamura T (2021) Constrictive pericarditis 20 years after surgical aortic valve replacement, Journal of General and Family Medicine, 10.1002/jgf2.501, 23:2, (122-123), Online publication date: 1-Mar-2022. Lucero O, Bustos M, Ariza Rodríguez D and Perez J (2022) Tuberculous pericarditis-a silent and challenging disease: A case report, World Journal of Clinical Cases, 10.12998/wjcc.v10.i6.1869, 10:6, (1869-1875), Online publication date: 26-Feb-2022. March 2019Vol 12, Issue 3 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.118.008726PMID: 30803258 Originally publishedFebruary 26, 2019 Keywordspericarditismagnetic resonance imaginginflammationtuberculosisPDF download Advertisement SubjectsMagnetic Resonance Imaging (MRI)Pericardial Disease