[Primary operation of pericardiectomy and decortication of the right lung for tuberculous pericarditis with empyema].

A 28-year old man who complained of ortho-apnea and fever was diagnosed to have cardiac tamponade. Pericardiocentesis was immediately carried out and peri-cardiac window was created on the 11th day. Typical caseating granulomas with acid-fast bacilli were detected in sections of the pericardium. A positive culture of Mycobacterium tuberculosis was observed in the sputum and the pericardial fluid. Though 3-month anti-tuberculosis treatment with streptomycin, isoniazid, and rifampicin was continued with 6-week steroid therapy, progressive thickness of the pericardium was suggested subsequent constriction. Pericardiectomy for pericarditis and decortication for empyema in the right thorax was performed at the same time. After 10 x 12 cm pericardium was resected through median sternotomy, decortication of the right lung was performed through right posterolateral thoracotomy. In the case with thickened pericardium, early pericardiectomy is recommended.