Right Heart Failure in Young People in Emerging Countries Is Most Commonly Secondary to Tuberculous Constrictive Pericarditis

Charbel Naim

doi:10.11648/j.ijcts.20190501.12

Abstract

Constrictive pericarditis is a rare disease with a challenging diagnosis and treatment. Tuberculous pericarditis accounts to 1-2% of the cases in the United States, but is the most common cause in other countries. We report a 17-year-old male presenting with right heart failure. His initial work up that included an Electrocardiogram, chest roentgenogram and echocardiogram suspected constrictive pericarditis. Right heart catheterization and cardiac MRI confirmed the diagnosis. Total Pericardiectomy was performed. Tissue PCR showed tuberculous pericarditis and the patient was treated with anti-tuberculous drugs for 9 months. Tuberculosis is a common cause of constrictive pericarditis especially in developing countries, whereas in developed countries most cases are idiopathic. To note that the diagnosis of tuberculous pericarditis can be difficult especially in negative PPD patients However It remains a common cause of constrictive pericarditis in some parts of the world where a high index of suspicion is requested. The treatment is curative and thus an aggressive approach in diagnosis and treatment is indicated.

Highlights

Constrictive Pericarditis is a relatively uncommon entity in contemporary practice
We report a 17-year-old male patient who was born and raised in Baghdad, Iraq, referred to us for intermittent jaundice and possible constrictive pericarditis
The pathologic diagnosis was fibrotic. This is the classic form of pericardial constriction due to calcific tuberculous pericarditis an entity that has become infrequent

Summary

Introduction

Constrictive Pericarditis is a relatively uncommon entity in contemporary practice. It is caused by fibrosis and calcification of the pericardium, leading to inhibition of diastolic filling of the heart. Clinical signs and symptoms are often vague. The diagnosis is challenging because it is necessary to differentiate this pathology from restrictive cardiomyopathy and other causes of right sided heart failure, such as pulmonary embolism, pulmonary hypertension, right ventricular infarction, mitral stenosis, and left ventricular systolic dysfunction. Accurate diagnosis is crucial because surgical intervention can provide complete relief of symptoms. [1] The majority of cases in the United States are of unknown etiology, but around 10% are viral, radiation induced, rhumatic, metabolic or tuberculous in origin. Tuberculosis is by far the most common cause of pericardial constriction

Case Report

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