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PubMed1986

[Echocardiography in a case of acute tuberculous pericarditis which progressed to constrictive pericarditis].

A case of acute tuberculous pericarditis with massive pericardial effusion progressed to constrictive pericarditis under echocardiographic observation during one year. This 59-year-old man was hospitalized because of dyspnea. On admission, his physical examination revealed a paradoxical pulse, engorged jugular veins, hepatomegaly, and pitting edema in the pretibial regions. Chest radiography revealed an enlarged cardiac silhouette and a marked left pleural effusion. His echocardiogram showed a massive pericardial effusion. A biatrial echogram recorded by esophageal echocardiography showed a massive pericardial effusion anterior to the right atrial free wall. Echocardiography performed four months after commencing therapy revealed a reduction in the pericardial effusion, and normal motion of the interventricular septum and posterior wall. However, the motion of the interatrial septum was already abnormal and the excursion of the right atrial free wall was markedly reduced. These finding were similar to those in constrictive pericarditis, as previously reported. Eleven months after admission, both conventional and esophageal echograms showed findings typical of constrictive pericarditis. Thus, in this case, the abnormal biatrial dynamics were recognized earlier than the abnormal left ventricular wall motion.

Echocardiography↗
PubMed1986

Tuberculous aortitis with associated necrosis and perforation: treatment and options.

Tuberculous aortitis is a rare entity and its association with necrosis and perforation is even more unusual. Our pulmonary medicine service originally evaluated an elderly woman with a right pleural effusion and upper lobe infiltrate thought to be tuberculosis. An abdominal CT scan performed at that time showed extensive periaortic adenopathy. Isoniazid and rifampin were started, but both were stopped by the patient after less than 6 months of therapy. The patient later had night sweats, a left pleural effusion, and a tender abdominal mass thought to be a symptomatic aneurysm. At operation, the aorta was necrotic and had an inflammatory mass and perforation on the left side. Infrarenal aortic ligation and resection were performed to control infection. A previously placed axillofemoral graft obviated the need for concomitant revascularization. The patient was treated postoperatively with isoniazid and rifampin until hyperbilirubinemia developed, which necessitated alternate therapy with ethambutol and streptomycin. The patient died one month after operation of a presumed pulmonary embolus.

Aged↗
PubMed1986

[A case of tuberculous abdominal aortic aneurysm which ruptured and perforated the sigmoid].

Tuberculous aneurysm is a very rare disease and the prognosis is not good. The authors carried out an emergency abdominal section on a 48 year old patient who had a serious hematochezia and vasography was performed on the patient in order to diagnose the bleeding site. However, the patient had a second serious hematochezia during vasography and fell into the state of shock. Laparotomy revealed innumerable tubercular knobs were and a seemingly tuberculous abdominal aortic knob, which ruptured and perforated to the sigmoid. The aorta was clamped above and below the knob and the knob was sutured and partially removed. A by-pass operation using an artificial blood vessel was carried out and the sigmoid was removed. After operation, acute renal insufficiency developed and the patient died suddenly 13 days after operation. The cause of the death is unknown because we could not perform autopy on this patient. Pathology of the resected specimen of the aorta showed the rest from which bleeding had occurred and caseous necrosis, expansion of cell infiltration and Langhans giant cells. Pathological diagnosis of the specimen was tubercuous aortic aneurysm.

Aorta, Abdominal↗