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Tuberculous pericardial abscess causing right ventricular obstruction
  1. K Caliskan,
  2. T W Galema,
  3. A P J Klootwijk

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A 33 year old Cabo Verdian woman presented with precordial chest pain and dizziness on exertion. Four months earlier she had successfully been treated because of systemic tuberculosis accompanied by ascites, pleural and pericardial effusion, and generalised lymphadenopathy. Physical examination showed a moderately ill patient with an elevated jugular venous pressure, a systolic murmur on the fourth left intercostal space, an enlarged liver, and pitting oedema on both legs. The ECG demonstrated sinus rhythm with normal intervals, voltages, and diffusely inverted T waves. Two dimensional echocardiography revealed a large extracardiac mass obstructing the free wall of the right ventricle (left panel). There was a moderate tricuspid insufficiency. Magnetic resonance imaging confirmed the echocardiographic findings, demonstrating a fluid containing mass of 5×6 cm with a very thick wall causing severe cavity reduction of the right ventricle (right panel).

Subsequently thoracotomy was performed. An abscess with a thick wall was encountered with infiltration of the right ventricular wall. The abscess was removed as much as possible. The “bottom” was left in place because of its continuation into the right ventricular wall. The fluid of the abscess was positive for acid-fast bacilli, confirming the diagnosis of a tuberculous abscess. Microscopic examination demonstrated granulomatous tissue with partial necrosis. The patient recovered quickly. Two weeks later the patient was discharged without residual signs of right sided heart failure. No new mass has recurred so far. Only a moderate tricuspid regurgitation remained on echocardiography.

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