Yousif Nooraldaem, Alnuwakhtha Abdulla, Darwish Abdulla, Arekat Zaid, Abdulrahman Seham
Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre (MKCC), Awali, Kingdom of Bahrain.
Department of Pathology, Royal Medical Services, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain.
Eur Heart J Case Rep. 2021 Sep 27;5(9):ytab328. doi: 10.1093/ehjcr/ytab328. eCollection 2021 Sep.
Constrictive pericarditis (CP) is one of the most serious sequelae of tuberculous pericarditis, which is characterized by heart constriction secondary to intense pericardial inflammation and thickening. Several invasive and non-invasive diagnostic modalities are crucial to address the challenges of confirming the diagnosis of CP and to expedite timely intervention.
This study reports the case of a Bahraini male with tuberculous lymphadenitis diagnosed with CP as a result of various evaluations. The patient underwent urgent total pericardiectomy and showed remarkable recovery with complete resolution of heart failure symptoms.
This case demonstrates the paramount importance of early diagnosis and treatment for patients with CP. In this unique case, the acoustic windows on echocardiography were suboptimal because of pericardial thickening. Further, computed tomography did not show significant calcification of the thickened pericardium. A novel approach of assessing haemodynamics through the right antecubital vein and right radial artery facilitated the accurate diagnosis of CP with confidence. Thereafter, successful pericardiectomy revealed a markedly thickened and stiff pericardium with many abscesses and dense adhesions encasing the heart, and pericardial biopsy showed large caseating granulomas. This case exemplifies the difficulty in diagnosing CP and the favourable outcomes achieved with well-timed surgical intervention.
缩窄性心包炎（CP）是结核性心包炎最严重的后遗症之一，其特征是由于强烈的心包炎症和增厚导致心脏受压。几种有创和无创诊断方法对于应对确诊CP的挑战以及加快及时干预至关重要。
本研究报告了一例巴林男性患者，因各种评估被诊断为结核性淋巴结炎合并CP。该患者接受了紧急全心包切除术，心力衰竭症状完全缓解，恢复显著。
该病例证明了CP患者早期诊断和治疗的至关重要性。在这个独特的病例中，由于心包增厚，超声心动图上的声学窗口不理想。此外，计算机断层扫描未显示增厚心包的明显钙化。一种通过右肘前静脉和右桡动脉评估血流动力学的新方法有助于准确自信地诊断CP。此后，成功的心包切除术显示心包明显增厚且僵硬，有许多脓肿和致密粘连包裹着心脏，心包活检显示有大片干酪样肉芽肿。该病例体现了CP诊断的困难以及及时手术干预所取得的良好结果。
