Brief communication

Echocardiographic abnormalities in tuberculous pericardial effusion

Clinical implications of the initial echocardiographic characteristics of pericardial effusion (PE) have not been clearly demonstrated. We sought to evaluate the clinical significance of echogenic materials in PE.

Echocardiographic evaluation was performed in consecutive 178 patients with moderate to severe PE, and the etiology of PE was determined by clinical and pathologic studies. Echocardiography was repeated for 46 ± 56 weeks.

Echo-free PE was shown in 142 patients (80%, group A), while echogenic PE was found in 36 patients (20%, group B). In group B, intrapericardial fibrinous strands and/or exudative frond-like materials were detected in 29 patients and diffuse echogenic PE was shown in 7 patients. The prevalence of echogenic PE was the highest in tuberculosis (56.3%). All 49 patients with uremia or congestive heart failure showed clear echo-free PE. During the follow-up, the incidence of constrictive pericarditis and recurrent PE were highest in malignancy (38.6%) and tuberculosis (31.3%), respectively. The incidence of constrictive pericarditis (3.5 vs. 27.8%, p < 0.001) and recurrent PE (9.2 vs. 22.2%, p < 0.05) were significantly lower in group A than group B. The echogenic PE was the major independent predictor of the events by multiple stepwise logistic regression analysis (p < 0.01), regardless of the PE etiology.

Echogenic materials in PE predict pericardial complications such as recurrence and constrictive pericarditis, irrespective of underlying diseases.

A patient with tuberculous pericardial effusion is described who presented with cardiac tamponade. Subsequent to pericardiocentesis, a large echodense intrapericardial mass was observed which disappeared completely with antituberculous chemotherapy. The resolution of the mass suggests that it was a conglomeration of fibrinous exudates deposited in the pericardial cavity. Presence of such exudates should not be considered an indication for surgical intervention.