Hashmani Shahrukh, Tipoo Sultan Fateh Ali, Masood Muhammad Qamar
Department of Cardiology, Aga Khan University Hospital, Karachi, Pakistan.
Department of Endocrinology, Aga Khan University Hospital, Karachi, Pakistan.
BMJ Case Rep. 2016 Oct 19;2016:bcr2016216964. doi: 10.1136/bcr-2016-216964.
We report a 22-year-old man who presented to the emergency department with worsening shortness of breath and chronic fever for 2 months. Physical examination was unremarkable except for raised jugular venous pressure and palpable liver. Echocardiogram showed a large right ventricular mass causing obstruction at tricuspid valve. A subsequent chest CT scan confirmed the presence of a large mass in the right ventricle. There were multiple enlarged lymph nodes and consolidation in the right upper lobe. Diagnosis of disseminated tuberculosis (TB) was made and later confirmed by histopathology of lymph node biopsy along with positive sputum culture for acid-fast bacilli. Remarkable recovery was observed on antituberculous therapy, with complete disappearance of the cardiac mass on echocardiogram, at 1-year follow-up. Although unusual and rare, myocardial involvement as a large mass should be kept in mind while treating patients with disseminated TB.
我们报告一名22岁男性，他因气短加重和持续2个月的慢性发热前往急诊科就诊。体格检查除颈静脉压升高和可触及肝脏外无异常。超声心动图显示右心室有一个大肿块，导致三尖瓣梗阻。随后的胸部CT扫描证实右心室存在一个大肿块。右上叶有多个肿大淋巴结和实变。诊断为播散性结核病，后来经淋巴结活检组织病理学检查及痰涂片抗酸杆菌培养阳性得以证实。抗结核治疗后观察到显著恢复，1年随访时超声心动图显示心脏肿块完全消失。虽然不常见且罕见，但在治疗播散性结核病患者时应考虑到心肌受累表现为大肿块的情况。
