Abstract
IntroductionTuberculosis (TB) can present both in its pulmonary or extra-pulmonary forms. Cardiac tuberculoma previously described only after autopsy is continuously seen with the advent of more advanced imaging modalities.Case reportA 23-year-old male with a four month history of a progressively increasing left anterior thoracic wall mass of 5 cm in diameter was referred from oncology for clinical re-evaluation and for echocardiography. Systemic examination was essentially normal. Transthoracic and trans-oesophageal echocardiography showed the presence of a pericardial mass around the right atrioventricular junction. Thoracic CT scan showed an anterior mass in left chest wall extending to the pericardium and also the presence of mediastinal lymphadenopathy. Mantoux test was positive and histological examination of tissue biopsy confirmed the presence of TB. However, blood tests and culture of aspirated purulent fluid were unyielding. A diagnosis of pericardial tuberculoma with mediastinal and parietal extension was made and patient was successfully treated with standard anti-TB chemotherapy.DiscussionThe possible differential diagnoses for chest wall tumors are varied and a high degree of suspicion is needed to diagnose cardiac tuberculoma especially in endemic regions. Imaging though helpful in morphological description cannot make precise diagnosis. The diagnosis depends on histological and culture studies. There is usually a good evolution with anti-TB treatment.ConclusionIn an era of an increasing number of acquired immune-compromised patients, and with increasing number of diagnoses of tuberculosis, a diagnosis of cardiac tuberculoma should be considered in patients presenting with a thoracic wall mass.
Highlights
Tuberculosis (TB) can present both in its pulmonary or extra-pulmonary forms
Six months after starting the aforementioned treatment there was a complete disappearance of the mass confirmed by echocardiography with no sign of constrictive pericarditis
The differential diagnosis of masses of the anterior and mid-mediastinum [8] includes thymomas, lymphomas, teratomatous neoplasms, thyroid masses, vascular masses, lymph node enlargement due to metastases or patients, and with increasing number of diagnoses of tuberculosis, a diagnosis of cardiac tuberculoma after a thorough clinical evaluation should be considered in patients presenting with a thoracic wall mass
Summary
Cardiac tuberculosis was first reported by Maurocordat in 1664 and by Morgagni in 1761 [6]. Patients, and with increasing number of diagnoses of tuberculosis, a diagnosis of cardiac tuberculoma after a thorough clinical evaluation should be considered in patients presenting with a thoracic wall mass. Whereas the diagnosis of cardiac tuberculoma was almost exclusively made at autopsy previously, advances in imaging techniques give an opportunity for earlier diagnosis. These advanced imaging techniques may contribute to an optimal morphologic description, assessment of hemodynamic significance as well as their surveillance [5]. They cannot help in distinguishing cardiac tuberculomas from other tumors. Surgical intervention may be required in large tuberculoma when pharmacotherapy alone is inadequate and in cases of severe hemodynamic compromise, threatening thromboembolism or refractory arrhythmias [9]
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