Cherian George, Uthaman Babu, Salama Abdulatif, Habashy Atef G, Khan Nazir A, Cherian Joseph M
Department of Medicine, Ministry of Health, Kuwait.
Angiology. 2004 Jul-Aug;55(4):431-40. doi: 10.1177/000331970405500410.
The clinical features with particular reference to tamponade and mediastinal adenopathy were studied in tuberculous pericardial effusion. Tamponade is a frequent complication and the recognition of tuberculous etiology can be difficult. Involvement of the pericardium is mostly from mediastinal lymph nodes that have not been studied. This was a prospective cohort study. All patients had large effusions, and underwent pericardiocentesis and chest computed tomography. Patients with tuberculosis had specific therapy. Others with viral/idiopathic effusion served as controls for the computed tomography studies. There were 26 patients with tuberculosis: 18 had tamponade on echocardiography. All had symptoms. Fever (n = 23) and dyspnea (n = 20) were the most frequent presenting symptoms. Pericardial rub was heard in 14, and 3 had enlarged cervical or axillary nodes. Pulmonary tuberculosis was present in 6. Tuberculin skin test measured 17 +/- 3.3 mm. The biopsy specimen showed a granuloma in 22 of 24. All 26 had mediastinal lymph nodes > 10 mm with a mean size of 19.5 +/- 8.6 mm that disappeared (81%) or regressed (19%) on treatment (p < 0.001). Aortopulmonary nodes were most frequently enlarged (65.4%) and hilar the least. Three required pericardiectomy. At follow-up all were doing well. None with viral/idiopathic effusion had lymph node enlargement. Fever, dyspnea, and tamponade were frequent with tuberculosis. The prognosis was good with specific therapy. Mediastinal nodes were enlarged in all and only with tuberculosis and not with viral/idiopathic effusion. Nodes disappeared or regressed with treatment. In the appropriate clinical context, mediastinal lymph node enlargement on chest computed tomography along with a strongly positive skin test results could help in the diagnosis of a tuberculous etiology of pericardial effusion.
本研究对结核性心包积液的临床特征，尤其是与心脏压塞和纵隔淋巴结肿大相关的特征进行了探讨。心脏压塞是一种常见的并发症，而结核病因的诊断可能存在困难。心包受累大多源于尚未得到研究的纵隔淋巴结。这是一项前瞻性队列研究。所有患者均有大量积液，并接受了心包穿刺术和胸部计算机断层扫描（CT）。结核病患者接受了特异性治疗。其他病毒/特发性积液患者作为CT研究的对照。共有26例结核病患者：18例经超声心动图检查发现有心脏压塞。所有患者均有症状。发热（n = 23）和呼吸困难（n = 20）是最常见的首发症状。14例可闻及心包摩擦音，3例有颈部或腋窝淋巴结肿大。6例合并肺结核。结核菌素皮肤试验测量值为17±3.3 mm。24例活检标本中有22例显示有肉芽肿。26例患者均有纵隔淋巴结>10 mm，平均大小为19.5±8.6 mm，治疗后消失（81%）或缩小（19%）（p<0.001）。主动脉肺淋巴结最常肿大（65.4%），肺门淋巴结最少。3例需要进行心包切除术。随访时所有患者情况良好。病毒/特发性积液患者均无淋巴结肿大。结核病患者常出现发热、呼吸困难和心脏压塞。特异性治疗预后良好。纵隔淋巴结肿大仅见于结核病患者，而病毒/特发性积液患者未见。治疗后淋巴结消失或缩小。在适当的临床背景下，胸部CT显示纵隔淋巴结肿大以及皮肤试验结果呈强阳性有助于诊断心包积液的结核病因。
