No abstract available.
Pericarditis, Tuberculous* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND AND OBJECTIVES: The identification of a specific etiology of effusive pericardial disease is difficult because of the limited yield of cytologic and microbiologic pericardial fluid analysis. We performed retrospective study to find out whether pericardial biopsy was superior to pericardial fluid analysis in search of the etiology of pericardial effusion. MATERIALS AND METHOD: We reviewed 76 cases of moderate to severe pericardial effusion on which we performed surgical pericardial biopsy from Sep. 1986 to Sep. 1996. The results of pericardial fluid analysis, clinical manifestation, pericardial biopsy were compared retrospectively. RESULTS: 1)Clinical diagnosis of pericardial effusion were as follow:neoplastic disease (7.9%), tuberculosis (72.4%), constrictive pericarditis (17.1%), and others (2.6%). 2)By the percutaneous pericardial biopsy, we confirmed 19 cases (25%). Etiology of 4 cases (5.3%) were malignancy and 15 cases (19.7%) tuberculosis. Fifteen out of 76 patients who were diagnosed by biopsy as tuberculous pericarditis and 28 patients who were suspected as tuberculous pericarditis clinically were treated with antituberculous medications. Ten patients (66.7%) of pathologically diagnosed patients and 18 patients (69.2%) of clinically diagnosed patients showed complete resolution of pericarditis. CONCLUSION: By pericardial biopsy, we only confirmed 19 cases (25.0%). It means that pericardial biopsy is not superior to pericardial fluid analysis in searching of etiology of pericardial effusion. Moreover, it is not sufficient for final diagnosis of pericardial effusion.
Biopsy* ; Diagnosis ; Humans ; Pericardial Effusion ; Pericarditis ; Pericarditis, Constrictive ; Pericarditis, Tuberculous ; Retrospective Studies ; Tuberculosis

We report aprimary malignant pericardial mesothelioma. Thirty-eight-year-old male patient complained of dyspnea and chest pain with left shoulder pain. At first, we thought it was because of tuberculous constrictive pericarditis and performed medical management for one and a half years. But, the above symptom recurred repeatedly; therefore we did pericardiectomy and diagnosed his case as malignant pericardial mesothelioma. Tumor was sticked to the myocardium and complete resection was impossible. He received postoperative chemoradiotherapy.
Chemoradiotherapy ; Chest Pain ; Dyspnea ; Humans ; Male ; Mesothelioma* ; Myocardium ; Pericardiectomy ; Pericarditis, Constrictive* ; Pericarditis, Tuberculous ; Pericardium ; Shoulder Pain

BACKGROUND AND OBJECTIVES: Tuberculous (TB) pericarditis is a major cause of constrictive pericarditis requiring pericardiectomy. We sought to determine initial prognostic factors in patients with TB pericarditis. SUBJECTS AND METHODS: We evaluated initial presentation and clinical outcomes (mean follow-up 32+/-27 months) in 60 consecutive patients newly diagnosed with TB pericarditis. RESULTS: Initial presentations were pericardial effusion (PE), effusive-constrictive pericarditis, and constrictive pericarditis in 45 (75%), 9 (15%), and 6 (10%) patients, respectively. Of the 54 patients without initial constrictive pericarditis, 32 (59%) showed echogenic materials in PE, including frond-like exudative coating and fibrinous strands. These patients had a longer disease duration before diagnosis, were initially more symptomatic, in a more advanced state, showed more persistent pericardial constrictions (38% vs. 0%, p<0.001) despite anti-TB medications, and tended to require pericardiectomy more often (19% vs. 0%, p=0.07, p<0.05 by Kaplan-Meier). All patients with effusive-constrictive pericarditis showed echogenic PE. Of the 60 total patients, 10 (17%) underwent pericardiectomies during follow-up. All of these patients showed initial pericardial constrictions, whereas no patient without initial pericardial constriction underwent pericardiectomy (p<0.001). Seven patients showed transient pericardial constrictions that resolved without pericardiectomy. CONCLUSION: Initial pericardial constriction and echogenic PE are poor prognostic signs for persistent pericardial constriction and pericardiectomy in patients with newly diagnosed TB pericarditis. These results suggest that early diagnosis and prompt anti-TB medication may be critical.
Constriction ; Early Diagnosis ; Echocardiography ; Fibrin ; Follow-Up Studies ; Humans ; Pericardial Effusion ; Pericardiectomy ; Pericarditis ; Pericarditis, Constrictive ; Pericarditis, Tuberculous ; Prognosis ; Tuberculosis

There is no diagnostic study for the presence of tuberculous pericarditis that is highly accurate as well as safe and easy to perform. As a result, the diagnosis is often delayed or missed, resulting in a clinical course characterized by increased mortality and late complications. Adenosine deaminase (ADA) in pleural or pericardial fluid is known for a useful marker of extrapulmonary tuberculosis. A 76-year old woman visited for dyspnea and generalized edema. Culture for sputum, pleural fluid, and pericardial fluid were negative for tubercle bacillus. But We diagnosed tuberculous pericarditis with pleuritis by increased titer of ADA activity in the pericardial fluid. After 2 weeks of initiation of antituberculous treatment, pericardial and pleural effusion gradually decreased while clinical symptoms improved markedly. Therefore, authors report a case of tuberculous pericarditis diagnosed by increased ADA activity in pericardial fluid with reviewing the previous literatures.
Adenosine Deaminase ; Aged ; Bacillus ; Diagnosis ; Dyspnea ; Edema ; Female ; Humans ; Mortality ; Pericarditis ; Pericarditis, Tuberculous* ; Pleural Effusion ; Pleurisy ; Sputum ; Tuberculosis

Primary pericardial mesothelioma is an extremely rare neoplasm with a bleak prognosis. It is often misdiagnosed as constrictive pericarditis initially, especially as tuberculosis pericarditis in Korea due to the high incidence of active tuberculosis. A targeted pericardial biopsy and noninvasive imaging modalities, such as delayed phase contrast chest computed tomography (CT) images and magnetic resonance imaging (MRI), can play an important role in the differential diagnosis of pericardial disease. We present the case of a 37-year-old man with a 3-week history of exertional dyspnea. A large pericardial effusion with pericardial thickening was noted, but its etiology was not revealed after conventional diagnostic procedures, including a closed pericardial biopsy. Empirical antituberculosis treatment was started, but the dyspnea recurred 5 months later. A malignant pericardial mesothelioma was diagnosed through a pericardiectomy and biopsy under direct visualization
Adult ; Biopsy ; Diagnosis, Differential ; Dyspnea ; Humans ; Incidence ; Korea ; Magnetic Resonance Imaging ; Mesothelioma ; Pericardial Effusion ; Pericardiectomy ; Pericarditis ; Pericarditis, Constrictive ; Pericarditis, Tuberculous ; Prognosis ; Thorax ; Tuberculosis

Adenosine deaminase(ADA) is an enzyme capable of catalysing the pathway from adenosine to inosine. Previous studies have shown that this enzyme may be useful in recognition of a tubeculous etiology of pleural, peritoneal, or meningeal effusions. ADA activity was studied in 42 patients with large amount of pericardial effusion. Patients were subdivided into the following four group : (A) 15 cases of tuberculous effusions : (B) 4 with pyogenic effusions : (C) 15 with idiopathic effusions : (D) 9 with malignant effusions. The results were as follows ; 1) The mean ADA activities assessed in pericardial effusions were 134.0+/-77.6U/L in group A : 93.8+/-43.8 in group B : 38.3+/-23.2 in group C : 27.3+/-20.8 in group D. Comparing the level achieved in group A with all others, the difference is significant at the P<0.001 level. 2) The mean ADA activities assessed in sera were 50.7+/-57.2 U/L in group A : 63.5+/-24.1 in group B : 25.9+/-12.0 in group C : 14.0+/-7.5 in group D. Comparing the level achieved in group A with all others, there is no significant difference. 3) Specificity(0.87) and sensitivity(0.93) of the test for the differential diagnosis of patients with tuberculous effusion from those with idiopathic effusion is high, when a value of more than 50 U/L is considered. In conclusion, the assessment of ADA in pericardial effusions is of great value in the diagnosis of tuberculous pericarditis.
Adenosine Deaminase* ; Adenosine* ; Diagnosis ; Diagnosis, Differential ; Humans ; Inosine ; Pericardial Effusion* ; Pericarditis, Tuberculous

Here, we report a case in which the rapid diagnosis of tuberculous pericarditis was made using Mycobacterium tuberculosis (MTB)-specific interferon-gamma release assay on peripheral blood and pericardial effusion. Acid-fast bacilli staining, mycobacterial culture, and nucleic acid amplification targeting MTB using pericardial fluid were negative. However, elevated adenosine deaminase (ADA) activity in pericardial fluid and interferon-gamma release assay positivity in both pericardial fluid and peripheral blood indicated the presence of tuberculous pericarditis. After anti-tuberculous and steroid treatment, the patient's clinical symptoms improved, and pericardial effusion has not reoccurred.
Adenosine Deaminase ; Diagnosis* ; Interferon-gamma Release Tests* ; Interferon-gamma* ; Mycobacterium tuberculosis ; Pericardial Effusion ; Pericarditis, Tuberculous*

We report here an unusual case of pericardial tuberculoma that was misdiagnosed as thymic carcinoma on an imaging study. A 48-year-old woman was referred for evaluation of an anterior mediastinal mass. Computed tomography (CT) scans of the chest displayed cystic masses mimicking thymic carcinoma at the anterior mediastinum. Pericardiotomy and surgical drainage of the cystic masses were done, and pathologic examination of the excised pericardial specimen showed a chronic granulomatous inflammation with necrosis, compatible with tuberculosis. Acid-fast bacilli were also identified in the specimen. After treatment with anti-tuberculosis drugs and steroids, the patient showed clinical improvement. Although tuberculous pericarditis usually presents as pericardial effusion or constrictive pericarditis, it can also present as a pericardial mass mimicking thymic carcinoma on CT. Therefore, we suggest that tuberculous pericardial abscess should be included in the differential diagnosis of a mediastinal mass in Korea, with intermediate tuberculosis prevalence.
Abscess ; Diagnosis, Differential ; Drainage ; Female ; Humans ; Inflammation ; Korea ; Mediastinum ; Middle Aged ; Necrosis ; Pericardial Effusion ; Pericardiectomy ; Pericarditis, Constrictive ; Pericarditis, Tuberculous ; Pericardium ; Prevalence ; Steroids ; Thorax ; Thymoma ; Thymus Neoplasms ; Tuberculoma ; Tuberculosis

BACKGOUND: Although the incidence has decreased markedly, mortality from uremic pericarditis still remained high at 8-10% due to hemodynamic compromise. Moreover, it is difficult to diagnose and discriminate from other causes of pericarditis such as tuberculous pericarditis in its early stage. The aim of this study was to analyze the factors that were related to the development of uremic pericarditis and factors that could distinguish it from other causes of pericarditis. METHODS: Eighteen patients who received pericardiocentesis due to uremic pericarditis from 1996 to 2005 in Korea university hospital were enrolled. All patients were diagnosed as severe uremic pericarditis by echocardiography. And as a comparison group, 37 patients with tuberculous pericarditis and 20 patients with malignant pericarditis were also enrolled. Analysis of the factors that were related to the development of uremic pericarditis or comparison of clinical, biochemical factors in uremic, tuberculous or malignant pericarditis were also done. RESULTS: In uremic pericarditis, the proportion of patients with peritoneal dialysis was higher (55.6%). The amount of pericardial effusion showed a positive correlation with the duration of dialysis, whereas showed negative correlation with hemoglobin and cholesterol levels. Pericardial fluid ADA was significantly higher in tuberculous pericarditis and pericardial fluid glucose was higher in uremic pericarditis. No specific factors that were related to the development of pericardial tamponade were identified. CONCLUSION: The development of severe uremic pericarditis might be related to poor nutritional status. In the early stage, ADA and glucose levels in pericardial fluid could be useful in distinguishing uremic pericarditis from tuberculous pericarditis. Prospective studies that enroll large patient population can be helpful in identifying factors that are related to the development of uremic pericarditis or tamponade.
Cardiac Tamponade ; Cholesterol ; Dialysis ; Echocardiography ; Glucose ; Hemodynamics ; Humans ; Incidence ; Korea ; Mortality ; Nutritional Status ; Pericardial Effusion ; Pericardiocentesis ; Pericarditis* ; Pericarditis, Tuberculous ; Peritoneal Dialysis