Approximately 8 million new cases of tuberculosis were reported to the World Health Organization in 1997, and millions are infected with HIV and tuberculosis.1 Tuberculous (TB) pericarditis is increasing in sub-Saharan Africa, where tuberculosis is the most common opportunistic infection complicating HIV infection, and is seen occasionally in developed countries.2 It is likely to increase worldwide, because of poor tuberculosis and HIV control and the ease of travel from high to low risk areas. TB pericarditis is important because it is treatable and many patients can be managed wholly or predominantly as outpatients.

Management of TB pericardial effusion involves relieving tamponade if present, confirming and treating tuberculosis, preventing constriction if possible, and offering pericardiectomy if it persists. Correct management presupposes diagnosis, which is not a problem where it is endemic,3 but may be where it is uncommon. It is a reminder that diagnosing “congestive heart failure” is incomplete without a cause, and that pericardial effusion is confirmed par excellence by echocardiography. For many in sub-Saharan Africa, this will be done simply, using the general purpose or obstetrical ultrasound machine.