Tuberculous pericarditis

Macroscopic pathology

• Here we have two transverse sections through a heart. 

• The lower section cuts through the left and right ventricles.

• The upper section has been made near the base of the heart where the great vessels enter and exit.

• 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. 

• This is the late stage of tuberculous pericarditis.

• Probably at an earlier stage there would have been an exudative effusion, amenable to aspiration.

• The bottle has been reversed.

Clinical data

• Unfortunately no clinical data was recorded for this patient.

• He would undoubtedly have had symptoms and signs of a constrictive pericarditis, such as dyspnoea and venous congestion.

• His heart has gradually been compressed and cardiac output reduced.

• 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.

• There would be ECG and echographic changes, and the pericardial thickening would best be seen on CT or MRI scan. 

• 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.