Porridge-like tuberculous cardiac tamponade: treatment difficulties in the Horn of Africa.
A 16-year-old boy was hospitalized for fever, chest pain, and cardiovascular collapse. Transthoracic echocardiography revealed a 30-mm circumferential echogenic "porridge-like" pericardial effusion with signs of cardiac tamponade. Tuberculosis (TB) was suspected because of its prevalence in Djibouti. Emergency pericardiocentesis was attempted, but only 10 ml of pericardial fluid was obtained. Subxiphoid pericardiotomy and drainage were then performed, and pericardial fibrinous pockets were surgically collapsed. Antituberculosis chemotherapy was given, and the pericardial effusion progressively disappeared without corticosteroids. The diagnosis of TB was subsequently confirmed by cultures of the pericardial fluid. A pericardial biopsy was normal. After 3 months of follow-up, there was no sign of constrictive pericarditis. Pericardiocentesis may fail in cases of advanced-stage fibrinous TB pericardial effusion. Thus, pericardiotomy with complete open draining is the only lifesaving procedure.
Massoure
Pierre-Laurent
PL
Hôpital Bouffard, Djibouti, SP 85024 00812, Armées, Republic of Djibouti. plmassoure@aol.com
Boddaert
Guillaume
G
Caumes
Jean-Luc
JL
Gaillard
Pierre-Emmanuel
PE
Lions
Christophe
C
Grassin
Frédéric
F
D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D015730:Djibouti; D004322:Drainage; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010492:Pericardiectomy; D020519:Pericardiocentesis; D010495:Pericarditis, Tuberculous / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
D000995:Antitubercular Agents