English

Abstract

INTRODUCTION: Pericardial tuberculosis remains a major problem in 3rd world countries. It is estimated to account for 70 % of large pericardial effusions & most cases of constrictive pericarditis in developing countries.(1,2) A 55 year old male presented with dyspnea on exertion and anasarca since 2 months. The patient had history of right sided pleural effusion 4 years ago and approximately 200 cc of fluid had been aspirated. The patient had not taken anti-tubercular treatment in the past. On examination the patient had bilateral pedal edema, raised JVP, hepatomegaly, ascites, and findings suggestive of right sided pleural effusion. Clinical features were suggestive of congestive heart failure. Chest X-ray (frontal & lateral) showed right sided pleural effusion and pericardial calcification. These findings were confirmed on CT. Pleural aspiration revealed thick pus. Pericardial calcification prompted us to consider constrictive pericarditis as one of the differential diagnosis. ECG revealed low voltage and T wave inversion, USG abdomen confirmed hepatomegaly & ascites. There was no evidence of portal hypertension. 2-D Echo revealed thick and calcified pericardium, septal bounce was not noted, IVC was not dilated but was not collapsing. Mitral E wave deceleration time was normal.