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Home > Student Cases > Tuberculous pericarditis

Tuberculous pericarditis

Macroscopic pathology

  • Here we have two transverse sections through a heart. 

  • The lower section cuts through the left and right ventricles.

  • The upper section has been made near the base of the heart where the great vessels enter and exit.

  • The pericardium is a double walled membranous sac that encloses the heart. Between the parietal (outer) and visceral (inner) pericardial layers lies the pericardial cavity, a slim, fluid-filled space, but here the pericardial cavity is grossly widened by large areas of caseation in a shell of organised fibrosis. 

Here we have two transverse sections through a heart.

 

  • This is the late stage of tuberculous pericarditis.

  • Probably at an earlier stage there would have been an exudative effusion, amenable to aspiration.

Here the pericardial cavity is grossly widened by large areas of caseation in a shell of organised fibrosis.

 

  • The bottle has been reversed.

Adherent  caseous lymph nodes at base of heart.


Clinical data

  • Unfortunately no clinical data was recorded for this patient.

  • He would undoubtedly have had symptoms and signs of a constrictive pericarditis, such as dyspnoea and venous congestion.

  • His heart has gradually been compressed and cardiac output reduced.

  • On ausculation the heart sounds would be muffled. A ‘pericardial knock’ might be heard; this is a early diastolic sound caused when the rigid pericardium abruptly halts ventricular filling.

  • There would be ECG and echographic changes, and the pericardial thickening would best be seen on CT or MRI scan. 

  • Tuberculosis is a rare cause of pericarditis and constrictive pericarditis in the developed world. However, tuberculous pericarditis is common in Africa and is increasing due to the HIV epidemic. Treatment is anti-tuberculous therapy and sometimes pericardiectomy is required. 

    Reference: Mutyaba AK, Ntsekhe M. Tuberculosis and the Heart. Cardiology Clinics. 2017; 35:135-144.

 


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