Takakura Hiroki, Sunada Kouichi, Shimizu Kunihiko
Kekkaku. 2016 Feb;91(2):65-8.
A 72-year-old man presented with fever, dyspnea, and weight loss. He was referred to our hospital for further examination of the cause of the pleural effusions. Chest computed tomography showed pleural effusions, a pericardial effusion, and enlarged lymph nodes in the carina tracheae. We administered treatment for heart failure and conducted analyses for a malignant tumor. The pericardial effusion improved, but the pericardium was thickened. Positron emission tomography-computed tomography (PET-CT) showed fluorine-18 deoxyglucose accumulation at the superior fovea of the right clavicle, carina tracheae, superior mediastinum lymph nodes, and a thickened pericardium. Because these findings did not suggest malignancy, we assumed this was a tuberculous lesion. Echocardiography confirmed this finding as constrictive pericarditis; therefore, pericardiolysis was performed. Pathological examination showed features of caseous necrosis and granulomatous changes. Hence, the patient was diagnosed with tuberculous constrictive pericarditis. PET-CT serves as a useful tool for the diagnosis of tuberculous pericarditis.
一名72岁男性出现发热、呼吸困难和体重减轻症状。他被转诊至我院以进一步检查胸腔积液的病因。胸部计算机断层扫描显示有胸腔积液、心包积液以及气管隆突处淋巴结肿大。我们对其进行了心力衰竭治疗并针对恶性肿瘤进行了分析。心包积液有所改善,但心包增厚。正电子发射断层扫描-计算机断层扫描(PET-CT)显示右锁骨上窝、气管隆突、上纵隔淋巴结及增厚的心包处有氟-18脱氧葡萄糖积聚。由于这些表现未提示恶性肿瘤,我们推测这是结核病变。超声心动图证实此发现为缩窄性心包炎;因此,进行了心包松解术。病理检查显示有干酪样坏死和肉芽肿性改变。因此,该患者被诊断为结核性缩窄性心包炎。PET-CT是诊断结核性心包炎的有用工具。