TUBERCULOUS CONSTRICTIVE PERICARDITIS

1. MEDIC TUBERCULOUS CONSTRICTIVE PERICARDITIS NGUYEN XUAN TRINH, MD Department of Cardiology, MEDIC

2. MEDIC Case Report • 25 M • Job: Supermarket Staff • Chief Complaint: fatigue, dyspnea, leg edema for the past 2 weeks • Bloat Jugular Vein (+). • Past medical history: No problems • Echocardiography , Abdominal Ultrasound • Chest X-Ray • Lab test

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5. MEDIC Chest X-Ray

6. MEDIC Lab Test

7. CARDIAC CTA-Normal Pericarium MEDIC Normal Pericardial Thickness : < 2mm J. P. Delille et al. Maximal thickness of the normal human pericardium assessed by electron-beam computed tomography. Eur. Radiol. 9, 1183-1189 (1999)

8. MEDIC CARDIAC CTA

9. MEDIC CARDIAC CTA

10. MEDIC CARDIAC CTA

11. MEDIC CARDIAC CTA

12. MEDIC CARDIAC CTA

13. MEDIC CARDIAC CTA

14. MEDIC CARDIAC CTA

15. MEDIC Preoperative Diagnosis 1. CONSTRICTIVE PERICARDITIS 2. RIGHT PLEURAL EFFUSION

16. Surgical resection- HCM Heart Institute MEDIC

17. Surgical resection MEDIC

18. Surgical resection MEDIC

19. MEDIC Histopathology

20. MEDIC Postoperative: Happy and follow-up treatment at Pham Ngoc Thach Hospital

21. MEDIC DISCUSSION

22. MEDIC Tuberculous pericarditis(TBP) • Rare but particularly severe complication, • Mortality of 80–90% when not handled properly and 12– 17% with appropriate treatment . • TB is responsible for about: • 4% of cases of acute pericarditis, • 7% of cases of cardiac tamponade • 6% of cases of constrictive pericarditis. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242

23. MEDIC • In a few underdeveloped countries, TB is the leading cause of pericarditis . • TBP incidence in developed countries is only 4% of all cases of TB but in some areas of South Africa, TBP represented 69.5% of pericarditis that required pericardial puncture for diagnosis . • In sub-Saharan Africa, the incidence of TBP is increasing due to the HIV epidemic, and this trend is likely to occur in other parts of the world due to HIV infection. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242

24. MEDIC • Tuberculous pericarditis diagnosis is difficult to establish in the absence of personal or family history suggesting a TB infection history or contact with another person with TB. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242

25. MEDIC • Although paraclinical methods of investigation such as classical radiology, CT, MRI, cytological exams, microbiological and even histopathology, it is sometimes difficult to specify the etiology of pericarditis. According to studies, tuberculous pericarditis constitutes to around 1–2% of all cases of pulmonary TB autopsied without clinically diagnosis Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242

26. MEDIC • PCR method to detect the presence of tuberculous bacilli in the pericardial fluid, which has directed the etiological diagnosis. • PCR positive value in the diagnosis of pericardial tuberculosis: PCR gave positive results in 80% of cases; other studies have shown that the PCR method is less sensitive than other methods, often giving false positive results Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242

27. MEDIC Management • Constrictive pericarditis has a progressive but variable course. • For most patients,surgical pericardiectomy is the definitive treatment. Martin M. Constrictive pericarditis . Braunwald Heart Disease 2019. P 1672-1675

28. MEDIC CONCLUSION • TBP is a rare disease, hard to diagnose in the absence of a known contact with a pulmonary TB contact. • Laboratory examination, such as chest radiography, CT, MRI and cardiac echography suggest the diagnosis; however, the certainty of tuberculous etiology is confirmed by evidentiating the Mycobacterium tuberculosis in the pericardic liquid or on histopathology slides. Milena Adina Man et al.Rom J Morphol Embryol.2016, 57(1):237–242

29. MEDIC THANKS FOR YOUR ATTENTION