Multimodality imaging of myocardial tuberculosis presenting as right ventricular cardiomyopathy: A case report

Abstract

An 18-year male with no significant past medical history presented with features of right-sided heart failure. Haematological investigations revealed raised erythrocyte sedimentation rate (23 mm/h). Transthoracic echocardiography (TTE) demonstrated biventricular systolic dysfunction with thickened free wall of right ventricle (RV). Whole-body fluorodeoxyglucose ( FDG) -positron emission tomography ( PET) computed tomography (FDG-PET-CT) showed intensely increased FDG uptake in the thickened RV wall and an FDG avid lesion in the left medial temporal lobe. Cardiac magnetic resonance imaging (CMR) characterized thickening and suggested an infiltrative disease (isointense on TI, hyperintense on myocardial oedema sensitive sequence with transmural enhancement on late gadolinium sequence). Magnetic resonance imaging (MRI) brain showed a thick rim enhancing ring lesion in the body of hippocampus. Endomyocardial biopsy revealed moderately dense lymphomononuclear inflammation with the formation of granulomas. Since tuberculosis is endemic in our country and considering all laboratory, imaging and biopsy findings a working diagnosis of tuberculosis was considered, and standard anti-tubercular treatment was started. There was an improvement in clinical status and follow-up imaging (TTE, CMR, brain MRI and FDG-PET-CT) showed improvement in biventricular function with regression in myocardial thickening and resolution of brain lesion, confirming the diagnosis of tuberculosis.

Insights into Imaging of Pericardial and Cardiac Tuberculosis: A Comprehensive Review

“…25 The tuberculous myocarditis cases were predominantly seen with concomitant pulmonary infection (56%) and concomitant pericarditis (43%). 1…”

“…Miliary tubercles of the heart , which are common in miliary TB patients, with the heart being one of several organs affected. 1…”

“…But these characteristic features of myocardial tuberculomas are rarely seen owing to rarity of disease and it can act as great masquerader of other cardiac mass. 1 In such cases, extracardiac focus of tuberculous infection may give a hint to the diagnosis. The treatment of myocardial tuberculomas primarily involves administration of antitubercular therapy (ATT) regimen.…”

“…Pericardial and cardiac involvement by tuberculosis (TB), though uncommon, is the second most common cause of TB-related deaths after cranial and spinal TB. 1 Tubercular involvement in the heart occur in the pericardium, myocardium, endocardium, or coronary arteries. 2 The diagnosis of isolated pericardial and cardiac TB is difficult since the clinical presentation is typically ambiguous, and traditional procedures, such as sputum smear microscopy, culture, and histology, have limited sensitivity and specificity.…”