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Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion
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  1. S George1,
  2. A L Salama1,
  3. B Uthaman2,
  4. G Cherian2
  1. 1Department of Cardiology, Chest Disease Hospital, Kuwait
  2. 2Department of Medicine, Faculty of Medicine, Kuwait University
  1. Correspondence to:
    Dr Susan George
    PO Box 1602, Ardhya 92400, Kuwait; samuelsusanyahoo.com

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Tuberculous pericarditis continues to have a high incidence in developing countries. Despite effective antimicrobial treatment and improved public health in developed countries, there has been a recent surge in the incidence of both atypical and classical tuberculosis in immunocompromised patients, especially those infected with HIV.

Only a few studies have been published describing the echocardiographic features of tuberculous pericardial effusion, especially with reference to echocardiographic intrapericardial abnormalities.1–5

The aim of this study was to evaluate the echocardiographic features of tuberculous pericardial effusion and assess the diagnostic and prognostic usefulness of echocardiographic intrapericardial abnormalities in distinguishing between patients with tuberculous pericardial effusion and idiopathic/viral pericardial effusion, which has not been previously studied.

METHODS

We analysed the medical records and echocardiograms of 27 consecutive patients with a discharge diagnosis of tuberculous pericardial effusion (group A), and 15 consecutive patients with a diagnosis of viral/idiopathic pericardial effusion (group B). A complete clinical history, physical examination, ECG, chest x ray and routine blood tests were performed in all patients. All patients underwent pericardiocentesis and three had surgical pericardiectomy. Pericardial biopsies were obtained at the time of pericardiocentesis. The pericardial fluid and biopsy specimens were sent for cytology, histopathology examination, acid fast bacilli staining, and culture for Mycobacterium tuberculosis.

The diagnosis of tuberculous pericarditis was based on either a positive M tuberculosis culture from the pericardial fluid or pericardial biopsy, detection of acid fast bacilli or a typical granuloma on histopathology, or the presence of pulmonary …

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