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Macroscopic pathology
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Here we have two transverse sections through a heart.
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The lower section cuts through the left and right ventricles.
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The upper section has been made near the base of the heart where the great vessels enter and exit.
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The pericardium is a double walled membranous sac that encloses the heart. Between the parietal (outer) and visceral (inner) pericardial layers lies the pericardial cavity, a slim, fluid-filled space, but here the pericardial cavity is grossly widened by large areas of caseation in a shell of organised fibrosis.
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This is the late stage of tuberculous pericarditis.
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Probably at an earlier stage there would have been an exudative effusion, amenable to aspiration.
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The bottle has been reversed.
Clinical data
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Unfortunately no clinical data was recorded for this patient.
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He would undoubtedly have had symptoms and signs of a constrictive pericarditis, such as dyspnoea and venous congestion.
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His heart has gradually been compressed and cardiac output reduced.
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On ausculation the heart sounds would be muffled. A ‘pericardial knock’ might be heard; this is a early diastolic sound caused when the rigid pericardium abruptly halts ventricular filling.
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There would be ECG and echographic changes, and the pericardial thickening would best be seen on CT or MRI scan.
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Tuberculosis is a rare cause of pericarditis and constrictive pericarditis in the developed world. However, tuberculous pericarditis is common in Africa and is increasing due to the HIV epidemic. Treatment is anti-tuberculous therapy and sometimes pericardiectomy is required.
Reference: Mutyaba AK, Ntsekhe M. Tuberculosis and the Heart. Cardiology Clinics. 2017; 35:135-144.