Exudative-constrictive tuberculous pericarditis in combination with arthritis in cardiologist practice: thoracoscopic biopsy as a diagnosis and treatment method

Abstract

The goal is to present the possibilities of diagnosis verification, the features of the clinical picture of tuberculous pericarditis in the therapeutic clinic and the results of its treatment. Materials and methods. The paper presents clinical observation and a general analysis of 10 cases of tuberculous pericarditis in patients aged 31-79 (mean age 58.0 ± 15.1 years), 6 women and 4 men. Diagnostic puncture pericardium was performed on two patients, pleural puncture - on three Thoracoscopic biopsy of hilar lymph nodes and lung (n=1), pleura (n=1), supraclavicular lymph node biopsy (n=1). Dyskin test was carried out, as well as sputum examination, multispiral computed tomography, oncological search. Results. A 31-year-old patient with a massive effusion in the pericardial cavity, pleural lesion, arthritis of the left knee joint, whose results of the pericardial effusion and sputum were not diagnosed, tuberculosis was detected only with thoracoscopic biopsy of the lung and intrathoracic lymph nodes; the treatment via prednisolone and subtotal pericardectomy was performed. Among 10 patients with MSCT of the lung, changes were noted in general, but in only one case they were highly specific. Diaskin test is positive in 70%. In the study of punctata, bronchoalveolar flushing, Koch bacteria were not detected; at sputum in microscopy and biological sample BC was detected in two patients. The lymphocytic character of effusion in the pericardium / pleura is noted in 4 out of 5 cases. At a biopsy of lymphonoduses and a lung at 2 patients the picture of a granulomatous inflammation with a caseous necrosis. Pericarditis was predominantly large (from 2 cm and more) effusion, signs of constriction were noted in 50% of patients. Conclusion. Tuberculosis is one of the frequent causes of pericarditis in the Moscow therapeutic clinic. The most lymphocytic effusion with fibrin and the development of constriction. The negative results of all laboratory tests for tuberculosis do not exclude a diagnosis, It is necessary to use invasive morphological diagnostics, including thoracoscopic biopsy.

Infectious-immune pericarditis: clinical assessment, diagnostics, and differentiated baseline therapy with hydroxychloroquine

“…Наш опыт показывает, что настойчивая диагностика, в т. ч. с применением повторных пункций перикарда и инвазивной биопсии, необходима во всех случаях неясных перикардитов и дает результаты [6,7]. Интересно и вполне закономерно, что одна из немногих (если не единственная) работа по изучению диагностической значимости перикардиоскопии и торакоскопической биопсии перикарда в России вышла из стен фтизиатрического учреждения, где применение методики позволило поставить диагноз туберкулезного перикардита у 44,4% больных [8].…”

Pericarditis in contemporary therapeutic clinic: nosological spectrum, approaches to diagnosis and treatment

“…3, а, см. на цветной вклейке), плевры (n=1), надключичного лимфоузла (n=1) [6]. В результате определенный диагноз туберкулезного перикардита поставлен 7 больным, у 3 он рассматривался как высоко вероятный.…”

Pericarditis. Clinical Guidelines 2022

“…Малоинвазивное чресплевральное вмешательство позволяет также осмотреть плевральные полости и взять дополнительный материал для исследования (ткань плевры, легких, лимфоузлов средостения, опухоли). Это позволяет улучшить диагностическое значение операции [176].…”

“…• Рекомендована резекция участка перикарда через миниторакотомию или торакоскопически для осмотра перикардиальной и плевральной полостей и взятия дополнительного материала для исследования (ткань плевры, легких, лимфоузлов средостения, опухоли) [167,171,[174][175][176].…”