Tuberculous Pericardial Effusion: Features, Tamponade, and Computed Tomography

Abstract

The clinical features with particular reference to tamponade and mediastinal adenopathy were studied in tuberculous pericardial effusion. Tamponade is a frequent complication and the recognition of tuberculous etiology can be difficult. Involvement of the pericardium is mostly from mediastinal lymph nodes that have not been studied. This was a prospective cohort study. All patients had large effusions, and underwent pericardiocentesis and chest computed tomography. Patients with tuberculosis had specific therapy. Others with viral/idiopathic effusion served as controls for the computed tomography studies. There were 26 patients with tuberculosis: 18 had tamponade on echocardiography. All had symptoms. Fever (n = 23) and dyspnea (n = 20) were the most frequent presenting symptoms. Pericardial rub was heard in 14, and 3 had enlarged cervical or axillary nodes. Pulmonary tuberculosis was present in 6. Tuberculin skin test measured 17 +/- 3.3 mm. The biopsy specimen showed a granuloma in 22 of 24. All 26 had mediastinal lymph nodes > 10 mm with a mean size of 19.5 +/- 8.6 mm that disappeared (81%) or regressed (19%) on treatment (p < 0.001). Aortopulmonary nodes were most frequently enlarged (65.4%) and hilar the least. Three required pericardiectomy. At follow-up all were doing well. None with viral/idiopathic effusion had lymph node enlargement. Fever, dyspnea, and tamponade were frequent with tuberculosis. The prognosis was good with specific therapy. Mediastinal nodes were enlarged in all and only with tuberculosis and not with viral/idiopathic effusion. Nodes disappeared or regressed with treatment. In the appropriate clinical context, mediastinal lymph node enlargement on chest computed tomography along with a strongly positive skin test results could help in the diagnosis of a tuberculous etiology of pericardial effusion.

Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography

“…Tamponade is a frequent complication of TB constrictive pericarditis, but patients do well with appropriate therapy [29]; abscess formation is a rare complication. Gulati et al [30] demonstrated 15 abscesses in 13 patients out of a group of 120 known to have constrictive pericarditis.…”

CT Findings in Patients With Pericardial Effusion: Differentiation of Malignant and Benign Disease

“…More important, mediastinal lymph node enlargement also was a significant finding of malignant pericardial effusion in patients with malignant disease. In the literature [28,29], mediastinal lymph node enlargement has been associated with tuberculous pericarditis. However, among nine cases of tuberculous pericarditis in our study, only two cases (22.2%) manifested mediastinal lymph enlargement.…”

Tuberculous pericarditis: three cases and brief review

“…Most commonly this is through the mediastinal lymph nodes [11]. Mediastinal node inflammation with subsequent central necrosis is a characteristic feature of TP [12] and was present in our second and third cases, where a chest CT was performed. Other routes of infection include hematogenous spread, contiguous spread from the lung, the visceral pleura or a diseased rib [13].…”