Hiroyama N, Matsuzaki M, Anno Y, Toma Y, Tamitani M, Maeda T, Konishi M, Okada K, Tanaka N, Suetsugu M
J Cardiogr. 1986 Jun;16(2):501-10.
A case of acute tuberculous pericarditis with massive pericardial effusion progressed to constrictive pericarditis under echocardiographic observation during one year. This 59-year-old man was hospitalized because of dyspnea. On admission, his physical examination revealed a paradoxical pulse, engorged jugular veins, hepatomegaly, and pitting edema in the pretibial regions. Chest radiography revealed an enlarged cardiac silhouette and a marked left pleural effusion. His echocardiogram showed a massive pericardial effusion. A biatrial echogram recorded by esophageal echocardiography showed a massive pericardial effusion anterior to the right atrial free wall. Echocardiography performed four months after commencing therapy revealed a reduction in the pericardial effusion, and normal motion of the interventricular septum and posterior wall. However, the motion of the interatrial septum was already abnormal and the excursion of the right atrial free wall was markedly reduced. These finding were similar to those in constrictive pericarditis, as previously reported. Eleven months after admission, both conventional and esophageal echograms showed findings typical of constrictive pericarditis. Thus, in this case, the abnormal biatrial dynamics were recognized earlier than the abnormal left ventricular wall motion.
1例急性结核性心包炎伴大量心包积液患者在1年的超声心动图观察期间进展为缩窄性心包炎。该59岁男性因呼吸困难入院。入院时，体格检查发现奇脉、颈静脉怒张、肝肿大及胫前区凹陷性水肿。胸部X线检查显示心影增大及明显的左侧胸腔积液。他的超声心动图显示大量心包积液。经食管超声心动图记录的双心房超声心动图显示右心房游离壁前方有大量心包积液。开始治疗4个月后进行的超声心动图显示心包积液减少，室间隔和后壁运动正常。然而，房间隔运动已经异常，右心房游离壁的偏移明显减少。这些发现与先前报道的缩窄性心包炎相似。入院11个月后，传统超声心动图和经食管超声心动图均显示缩窄性心包炎的典型表现。因此，在该病例中，双心房动力学异常比左心室壁运动异常更早被识别。
