• Journal of Chest Surgery
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• v.16 no.2
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• pp.184-189
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• 1983

Between 1958 and 1982, 70 patients have undergone pericardiectomy for constrictive pericarditis at the Thoracic Department of Seoul National University Hosp. 58 males and 12 females, with an average age of 27 years [ranging 3 to 60 years], of which 55% were between 10 and 30 years old, were treated. Eight patients died, of whom 4 were in the immediate postoperative period, less that 24 hours after operation. The cause of death was myocardial failure in 3 patients and hypotension during operation in one patient. The remaining four deaths occurred between the fifth and eighteenth postoperative day, and the causes of death varied: bilateral phrenic nerves injury, congestive heart failure, dissemination of tuberculosis, and cardiac arrest. Two patients suffered from congestive heart failure pre-and postoperatively due to the associated valvular heart disease. There were 8 wound infections on which resulted in perichondritis of costal cartilages requiring segmental resection 2 months later. There was one postoperative bleeding requiring immediate reopening for bleeding control. Tuberculosis was confirmed as the cause of constrictive carditis in 27 patients [39%]. Acute pyogenic pericarditis was precursor in 8 patients [11%]. In 2 patients [2.9%], the constrictive pericarditis developed following OHS. Both suffered from congestive heart failure postoperatively due to the residual valvular heart disease. In the others, the cause of the constrictive pericarditis was considered idiopathic or non-specific inflammation.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1245-1249
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• 1992

Tuberculosis developed in the pericardium usually occurs as diffuse constrictive pericarditis or effusive pericarditis which contains much pericardial effusion. But types such as localized abscess or tuberculoma are very rare. Myocardial tuberculosis is also very rare and mainly extended directly from hilar lymph node or spreaded hematogenously in miliary tuberculosis. It is known to be able to make arrhythmia or heart failure by invasion of conduction system or myocardial muscle mass, but it is usually discovered by incidental postmortem autopsy and rarely concerned by clinical basis. Recently we have experienced a case of localized intrapericardial tuberculous abscess which extended to myocardium and operated that successfully. So we would report them with reference study.

• Journal of Chest Surgery
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• v.27 no.9
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• pp.793-797
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• 1994

Constrictive pericarditis is often accompanied with ~brothorax and deterioration of cardiac, hemodynamic functions. Surgical relief of fibrous peel causes remarkable improvement in pulmonary, cardiac, hemodynamic function, and subjective symptoms. We experienced 4 cases of constrictive pericarditis combined with bilateral ~brothorax after bilateral pleural effusion caused by tuberculosis and non-specific inflammation. Pleural decortication and pericardiectomy were done at the same time through anterolateral thoracotomy with sternal transection[3 patients] and median sternotomy incision[l patient]. Low cardiac output was the most common complication. With left anterolateral thoracotomy, we could prevent the hypotension from massive retraction for dissecting by median sternotomy, which was good for dissecting from anterior wall of left ventricle to posterior wall of left ventricle and surrounding phrenic nerve. It was enough to dissect the portion being through hard to dissect, right atrium, SVC and IVC.

• Journal of Chest Surgery
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• v.7 no.2
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• pp.179-188
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• 1974

An analysis of &5 cases of constrictive pericarditis treated surgically in this department of Seoul National University Hospital between the years 1958 and 1974 has been presented. 1.Of the patients with constrictive pericarditis,29 were males and 6 were females. Their ages averaged 23.8 years. 2. All patients who had pericardiectomy showed excellent postoperative results, and no operative mortality was noted in this group of patients but 3 hospital death [9.1%] occurred. 3. Besides shortening of circulation time elevated venous pressure was restored to normal range after pericardiectomy from a preoperative average 25.8cm $H_2O$ to a postoperative average 14.8cm $H_2O$. 4. Electrocardiographic changes consisted chiefly of low voltage complexes, P-wave and T-wave changes and characterized by vertical or semivertical heart position. The ECG was returned to normal or near normal after Pericardiectomy. 5. There were seven postoperative complications in this series. 6. In ten cases [32.3%], the pathology revealed evidence of tuberculosis in the pericardium or the myocardium, and others were described as chronic, proliferative, fibrous pericarditis or hyalinization of the pericardium.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.317-322
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• 1987

Records of 15 patients who underwent operation for constrictive pericarditis at this department from 1976 through 1984 were reviewed. All had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. There were 12 males and 3 females in this series. Range of age varied from 7 years to 51 years. Clinical and histological study revealed granulomatous pericarditis compatible with the diagnosis of tuberculosis in 5 patients, non-specific chronic inflammatory changes in 6 patients and pyogenic pericarditis in 2 patients. Pericardiectomy was performed through a median sternotomy [11 cases] or bilateral anterior thoracotomy [4 cases]. The postoperative complications were observed in 4 patients. Low cardiac output was the most common complication [2 patients]. In 13 cases, excluding 2 operative deaths, preoperatively all were in New York Heart Association Class III or IV. At the time of discharge II [85%] were in Class I or II. 4 Cases were reoperated after original pericardiostomy and all resulted in marked improvement. Early surgical intervention is advisable in all patients in whom cardiac constriction is caused by either a thickened pericardium or a pericardial effusion before myocardial dysfunction occurs.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.197-203
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• 2024

Tuberculous pericarditis is an extrapulmonary manifestation of tuberculosis that is most commonly associated with pericardial thickening, effusion, and calcification. We present a case of tuberculous pericarditis mimicking a malignant pericardial tumor in a 77-year-old male. CT revealed an irregular and nodular pericardial thickening. MRI revealed high signal intensity on T1-weighted fat-suppressed images and peripheral rim enhancement after gadolinium administration. MRI can be helpful in determining the differential diagnoses in cases of tuberculous pericarditis with nonspecific imaging findings.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.522-526
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• 2008

A 63-year old woman was admitted to our hospital for an evaluation of thrombocytopenia. She had been diagnosed with tuberculous pericarditis three months earlier in a local clinic and treated with anti-tuberculosis medication. Two months later, thrombocytopenia developed. The medication was subsequently stopped because it was suspected that the anti-tuberculosis medication, particularly rifampin, might have caused the severe platelet reduction. However, the thrombocytopenia was more aggravated. A bone marrow biopsy was performed, which showed moderate amounts of histiocytes with active hemophagocytosis. This finding strongly suggested that the critical thrombocytopenia had been caused by hemophagocytic syndrome, not by the side effects of the anti-tuberculosis medication. Furthermore, the development of hemophagocytosis might have been due to an uncontrolled tuberculosis infection and its associated aberrant immunity. Therefore, she was started with both standard anti-tuberculosis medication and chemotherapy using etoposide plus steroid. One month after the initiation of treatment, the thrombocytopenia had gradually improved and she was discharged in a tolerable condition. At the third month of the follow-up, her platelet level and ferritin, the activity marker of hemophagocytic syndrome, was within the normal range.

• The Korean Journal of Nuclear Medicine
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• v.35 no.4
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• pp.280-285
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• 2001

We present a case of a 31 year-old male patient with tuberculous pericarditis with mediastinal mass that showed increased uptake on Gallium-67 image. Gallium-67 scan was performed to evaluate the activity of the superior mediastinal mass, which was detected on chest CT. A rim of intense activity around the heart was observed, but increased uptake was not seen in the mediastinum. However, on maximal contrast-enhanced SPECT images, a small focus of faint uptake was observed in the superior mediastinum. This finding implied that there was an active tuberculosis in the pericardium and inflammation in the superior mediastinal mass. This case demonstrated that Gallium-67 scinitigraphy was helpful for the diagnosis of tuberculous pericarditis.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.67-73
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• 1989

Forty two patients with chronic constrictive pericarditis, who were admitted to the Yonsei University College of medicine over a period of 18 years from January, 1970 to August, 1988, were analyzed retrospectively. Mean age of the patient was 33.5 year ranging from 6.8 to 60 years old. Male to female ratio was 1.3 to 1. Twenty-one cases [50%] were tuberculous origin [based on either associated pulmonary tuberculosis and/or caseous necrosis in thickened pericardial specimen] and 17 cases [40.5%] were idiopathic [non specific chronic inflammatory change was considered to be idiopathic]. Dyspnea on exertion was evident in 30 cases [71.4%] and abdominal distention in 21 cases [50%]. On physical examination, hepatomegaly [83.3%], neck vein distention [54.8%], distant heart sound [47.6%] and ascites were found. Thirty-nine patients showed low voltage of QRS and/or T wave flattening or inversion on EKG. Thirty-one cases had undergone cardiac catheterization which showed data compatible with chronic constrictive pericarditis. Midsternostomy group [n=15] had shown the most remarkable CVP decline [12.20 mmHg] as compared with bilateral submammary incision group [n=25, 8.96 mmHg] and left thoracotomy group [n=2, 7.75 mmHg] but difference was not significant statistically There was four early death among 42 patients [9.5%] including 3 cases of left ventricular failure and one cardiac tamponade. Main postoperative complications were wound infection [6 cases] and arrhythmia [3 cases]. Follow-up of 24 patients [mean; 55.3 months, ranging from 2 months to 155 months] revealed good functional status.

• Tuberculosis and Respiratory Diseases
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• v.70 no.4
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• pp.347-351
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• 2011

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.