Sabzi Freidoun, Faraji Reza, Khoshnood Saeed
Department of General Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Tuberculosis and Lung Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran.
Glob Cardiol Sci Pract. 2024 Aug 1;2024(4):e202436. doi: 10.21542/gcsp.2024.36.
Right atrial tuberculoma (RAT) are an exceedingly rare heart mass often caused by primary pulmonary tuberculosis (TB) in patients infected with human immunodeficiency virus (HIV). In HIV patients, the right atrium is not only a suitable location for tuberculoma formation, but also has a tendency for thrombus formation due to the thrombophilic state of HIV and the destructive effect of the HIV virus on the endothelial surface of the right atrium and subsequent thrombus formation. These masses can simply be detected by transthoracic echocardiography (TEE), but their differentiation from other cardiac pathologies requires histological examination. Herein, using a positive polymerase chain reaction test, we report a case of a previously diagnosed HIV-positive 24-year-old man who presented with a right atrial thrombus, dyspnea, and pleural effusion. Final histological examination identified the right atrial thrombus as a tuberculoma. The patient underwent open heart surgery to remove the mass and received prolonged postoperative TB therapy together with HIV drugs. Three-month follow-up showed some remaining dyspnea and lower extremity edema; however, TEE showed no recurrence of the RAT or thrombus.
右心房结核瘤（RAT）是一种极其罕见的心脏肿物，通常由感染人类免疫缺陷病毒（HIV）的患者的原发性肺结核引起。在HIV患者中，右心房不仅是结核瘤形成的合适部位，而且由于HIV的血栓形成倾向状态以及HIV病毒对右心房内皮表面的破坏作用和随后的血栓形成，还具有血栓形成的倾向。这些肿物可通过经胸超声心动图（TEE）简单检测到，但要将它们与其他心脏病变区分开来需要进行组织学检查。在此，通过聚合酶链反应检测呈阳性，我们报告一例先前诊断为HIV阳性的24岁男性病例，该患者出现右心房血栓、呼吸困难和胸腔积液。最终组织学检查确定右心房血栓为结核瘤。患者接受了心脏直视手术以切除肿物，并在术后接受了长时间的抗结核治疗以及HIV药物治疗。三个月的随访显示仍有一些呼吸困难和下肢水肿；然而，TEE显示RAT或血栓未复发。
