Kudoh Y, Kijima T, Sugita J, Moriyama H, Iimura O
Division of Cardiology, South-1 Hospital; Sapporo, Japan.
Jpn Circ J. 1989 May;53(5):416-9. doi: 10.1253/jcj.53.416.
The patient presented in this paper had been stable for 3 months after the induction of hemodialysis, when nausea, vomiting and hepatomegaly suddenly developed. A chest film revealed rush cardiomegaly, and massive pericardial effusion was demonstrated by echocardiography. One liter of hemorrhagic fluid was removed by pericardiocentesis and subsequent pericardial drainage under echocardiography. The patient received chemotherapy against pulmonary tuberculosis 30 years ago and calcification on chest film was apparent. Although sputum smear and pericardial effusion was negative for acid-fast organisms, combination therapy was initiated for suspected tuberculosis. The patient recovered completely and 2 months later it was demonstrated that cultures of sputum grew mycobacterium tuberculosis. Tuberculin skin test (PPD), which was negative 2 months previously, converted to positive. Tuberculosis must be considered as a potential cause of pericardial tamponade in patients on regular hemodialysis, and prompt therapy for both cardiac tamponade and the occult infection is warranted.
本文所介绍的患者在血液透析诱导后已稳定3个月，此时突然出现恶心、呕吐和肝肿大。胸部X光片显示心脏扩大，超声心动图显示大量心包积液。通过心包穿刺术及随后在超声心动图引导下进行心包引流，排出了1升血性液体。该患者30年前接受过抗肺结核化疗，胸部X光片上可见钙化。尽管痰涂片和心包积液中抗酸菌检测均为阴性，但鉴于怀疑为结核病，仍开始进行联合治疗。患者完全康复，2个月后痰培养结果显示生长出结核分枝杆菌。2个月前结核菌素皮肤试验（PPD）为阴性，此时转为阳性。对于定期进行血液透析的患者，必须将结核病视为心包填塞的潜在病因，同时应及时对心脏填塞和隐匿性感染进行治疗。
