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

No abstract available.
Pericarditis* ; Pericarditis, Constrictive*

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

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

No abstract available.
Echocardiography* ; Pericarditis, Constrictive*

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

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

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

Fifty-seven patients underwent 58 pericardiectomies for constrictive pericarditis during the 22-year period between 1958 and 1979. They were 43 males and 14 females with peak age incidence in the second decade, and 26.3% of them were children under 15 years. The etiologies of pericarditis were tuberculous in 40.3%, non-specific in 38.0%, pyogenic in 19.3%, and post-traumatic in 1.8%. Clinical features were alomost identical with those described in the other major reports. Pericardial calcification was noted in 29.8%, pleural change in 63.2% and enlarged cardiac shadow in 73.7% on the chest roentgenograms; atrial fibrillation in 15.8% and low voltage in 45.6% on the electrocardiograms. Venous pressures were elevated and circulation times prolonged. Right heart catheterization were performed in near half of the cases which revealed the characteristics of pericardial constriction. There were 7 deaths after surgery or the hospital mortality rate of 12.3%. The most common and fatal complication was arrhythmia, especially sudden cardiac arrest occurred in pyogenic pericarditis of children. Fifty patients manifested marked clinical improvement from early postoperative days and all were discharged from hospital in excellent condition. Follow-up observations were possible in 30 cases(60.0%) for the average period of one year seven months when all were completely free of symptoms and had normal physical examinations. Abnormal preoperative electrocardiographic changes also revealed the tend-ency toward normalization from early postoperative days except persisting T-Changes. The grave prognosis of pyogenic pericarditis in children and the importance on careful consideration about early pericardiectomy for active tuberculous pericarditis were stressed. And, discussion was also made on the correlation between clinical improvement and hemod ynamic changes after pericardiectomy. Special interest was placed on the preoperative electrocardiographic patterns resembling right ventricular hypertrophy in constrictive pericarditis and the mechanism of its return to normal after surgery.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Constriction ; Death, Sudden, Cardiac ; Electrocardiography ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Pericardiectomy* ; Pericarditis ; Pericarditis, Constrictive* ; Pericarditis, Tuberculous ; Physical Examination ; Prognosis ; Thorax ; Venous Pressure