The Clinical Course of Tuberculous Pericarditis in Immunocompetent Hosts Based on Serial Echocardiography

Min Sun Kim,Sung-A Chang,Eun Kyoung Kim,Jin-Oh Choi,Sung-Ji Park,Sang-Chol Lee,Seung Woo Park,Jae K. Oh 대한심장학회 2020 Korean Circulation Journal Vol.50 No.7

Background and Objectives: In East Asia, tuberculous pericarditis still occurs in immunocompetent patients. We aimed to investigate clinical course of tuberculous pericarditis and the trends of echocardiographic parameters for constrictive pericarditis. Methods: We retrospectively analyzed medical records of patients with tuberculous pericarditis between January 2010 and January 2017 in Samsung Medical Center. Treatment consists of the standard 4-drug anti-tuberculosis regimen for 6 months with or without corticosteroids. We performed echocardiography at initial diagnosis, 1, 3 and 6 months later. Results: Total 50 cases with tuberculous pericarditis in immunocompetent patients were enrolled. Echocardiographic finding at initial diagnosis divided into 3 groups: 1) pericardial effusion only (n=28, 56.0%), 2) effusive constrictive pericarditis (n=10, 20.0%) and 3) constrictive pericarditis (n=12, 24.0%). The proportion of patients with constrictive pericarditis decreased gradually over time. After 6 months, only 5 patients still had constrictive pericarditis. Out of the 28 patients who initially presented with effusion alone, only one patient developed constrictive pericarditis. Echocardiographic parameters representing constrictive pericarditis gradually disappeared over the follow up period. Ventricular interdependency improved significantly from 1 month follow-up, whereas septal bounce and pericardial thickening were still observed after 6 months without significant constrictive physiology. Conclusions: Tuberculous pericarditis with pericardial effusion without constrictive physiology is unlikely to develop into constrictive pericarditis in immunocompetent hosts, if treated with optimal anti-tuberculous medication and steroid therapy. Even though there were hemodynamic feature of constrictive pericarditis, more than 80% of the patients were improved from constrictive pericarditis.

Acute pericarditis mimicking acute coronary syndrome in a patient with hyperthyroidism

( Eun Yong Choi ),( Jin Bae Kim ),( Won Suck Jang ),( Jung Hun Lee ),( Woo Sik Kim ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2

Back ground: Acute pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub, and serial electrocardiographic changes. It is caused by a variety of disorders. Most cases of acute pericarditis without any initial apparent cause are idiopathic, although presumably viral in origin. Generally, acute pericarditis is benign and self-limiting, but it is difficult to clearly identify the cause. Unlike viral infection orother causes, thyrotoxicosis is not one of the common causes of acute pericarditis and hasonly rarely been reported. Patient finding: A 31-year-old woman presenting with three-day history of chest painand dypnea. Investigations revealed hyperthyroidism and pericarditis. In laboratory studies, troponin I was elevated up to 0.12 ng/mL (normal, 0.00 to 0.04 ng/mL), and AST/ALTwas 91/93 U/L. Other lab finding including viral marker and CRP, ESR was within normallimited. The electrocardiogram showed a sinus rhythm of 76 beats per minute, a lowvoltage QRS, and a negative T-inversion of 2 mm in precordial leads V1~V2, but no STchanges and no Q waves were present. A chest roentgenogram revealed pulmonary edemaand echocardiography revealed pericardial thickening and diastolic dysfunction and scantypericardial effusion. After treatment with beta blocker, nonsteroidal anti-inflammatory drugsand anti thryoid medication, symptom was relieved and she was discharged on the fourth day after admission in a stable condition. Summary: A young woman with hyperthyroidism underwent pericarditis. There was noevidence of other causes of pericarditis such as infections, autoimmune diseases, or drugs. Here, we report the case of a young patient with acute pericarditis as a complication of hyperthyroidism; Conclusion: We reported a case of acute pericarditis caused by hyperthyroidism. It sclinical course was benign, similar to other cases of viral pericarditis.

Prognostic Value of Initial Echocardiographic Features in Patients With Tuberculous Pericarditis

최형오,송종민,심태선,김상현,정인현,강덕현,송재관 대한심장학회 2010 Korean Circulation Journal Vol.40 No.8

Background and Objectives: Tuberculous (TB) pericarditis is a major cause of constrictive pericarditis requiring pericardiectomy. We sought to determine initial prognostic factors in patients with TB pericarditis. Subjects and Methods: We evaluated initial presentation and clinical outcomes (mean follow-up 32±27 months) in 60 consecutive patients newly diagnosed with TB pericarditis. Results: Initial presentations were pericardial effusion (PE), effusive-constrictive pericarditis,and constrictive pericarditis in 45 (75%), 9 (15%), and 6 (10%) patients, respectively. Of the 54 patients without initial constrictive pericarditis, 32 (59%) showed echogenic materials in PE, including frond-like exudative coating and fibrinous strands. These patients had a longer disease duration before diagnosis, were initially more symptomatic, in a more advanced state,showed more persistent pericardial constrictions (38% vs. 0%, p<0.001) despite anti-TB medications, and tended to require pericardiectomy more often (19% vs. 0%, p=0.07, p<0.05 by Kaplan-Meier). All patients with effusive-constrictive pericarditis showed echogenic PE. Of the 60 total patients, 10 (17%) underwent pericardiectomies during follow-up. All of these patients showed initial pericardial constrictions, whereas no patient without initial pericardial constriction underwent pericardiectomy (p<0.001). Seven patients showed transient pericardial constrictions that resolved without pericardiectomy. Conclusion: Initial pericardial constriction and echogenic PE are poor prognostic signs for persistent pericardial constriction and pericardiectomy in patients with newly diagnosed TB pericarditis. These results suggest that early diagnosis and prompt anti-TB medication may be critical.

Constrictive Pericarditis as a Never Ending Story: What’s New?

손대원 대한심장학회 2012 Korean Circulation Journal Vol.42 No.3

Nowadays, we have a better understanding of the natural history of constrictive pericarditis such as transient constriction. In addition,we have acquired the correct understanding of hemodynamic features that are unique to constrictive pericarditis. This understanding has allowed us to diagnose constrictive pericarditis reliably with Doppler echocardiography and differentiation between constrictive pericarditis and restrictive cardiomyopathy is no longer a clinical challenge. The advent of imaging modalities such as CT or MR is another advance in the diagnosis of constrictive pericarditis. We can accurately measure pericardial thickness and additional information such as the status of coronary artery and the presence of myocardial fibrosis can be obtained. We no longer perform cardiac catheterization for the diagnosis of constrictive pericarditis. However, these advances are useless unless we suspect and undergo work-up for constrictive pericarditis. In constrictive pericarditis, the most important diagnostic tool is clinical suspicion. In a patient with signs and symptoms of increased systemic venous pressure i.e. right sided heart failure, that are disproportionate to pulmonary or left sided heart disease, possibility of constrictive pericarditis should always be included in the differential diagnosis.

Klebsiella 급성 심낭염 1예

제석준,신경순,서경희,이덕현,최희진,황중하,이병기,이중기 慶北大學校 醫科大學 1998 慶北醫大雜誌 Vol.39 No.2

A successfully treated case of primary purulent pericarditis complicated by cardiac tamponade and pneumopericardium

범종욱,고이경,부기영,이재근,최준혁,주승재,문지환,김수완,김송이 대한중환자의학회 2021 Acute and Critical Care Vol.36 No.1

Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern antibiotics era. We report a successfully treated case of primary purulent pericarditis complicated with cardiac tamponade and pneumopericardium in an immunocompetent host. A 69-year-old female was referred from another hospital because of pleuritic chest pain with a large amount of pericardial effusion. She was diagnosed with acute pericarditis accompanied by cardiac tamponade. We performed emergency pericardiocentesis, with drainage of 360 ml of bloody pericardial fluid. The culture grew Streptococcus anginosus, confirming the diagnosis of acute purulent pericarditis. We performed pericardiostomy because cardiomegaly and pneumopericardium were aggravated after removal of the pericardial drainage catheter. The patient received antibiotics for a total of 23 days intravenously and was discharged with oral antibiotic therapy. Purulent pericarditis is one of the rare forms of pericarditis and is life-threatening. A multimodality approach is required for proper diagnosis and treatment of this disease.

Case Report : Acute Purulent Staphylococcal Pericarditis with Cardiac Tamponade in a Hemodialysis Patient

( Ji Youn Kim ),( Seon Wook Park ),( Seung Hwa Lee ),( Yong Wook Kim ),( Min Kyu Kim ),( Tae Jin Park ),( Jang Won Seo ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1

Purulent pericarditis is a rare disease in both end-stage renal disease (ESRD) patients and the general population. We report herein a case of acute purulent staphylococcal pericarditis with cardiac tamponade managed by intravenous antibiotics and pericardiocentesis with drainage. A 54-year-old man with ESRD, who had been on hemodialysis (HD) for the previous six months, was admitted to the hospital because of fever. He had a history of a recent episode of staphylococcal bacteremia associated with venography for arteriovenous fistula (AVF) malfunction. On the sixth day after admission, severe intradialytic hypotension arose during HD. Echocardiography showed a large pericardial effusion with hemodynamic significance. Emergency pericardiocentesis with drainage was performed. Acute purulent staphylococcal pericarditis with cardiac tamponade was diagnosed and intravenous vancomycin was administered for four weeks. On the 23rd day, the patient was discharged from the hospital after the drainage catheter`s removal. Ten days after discharge, however, he was re-admitted because of dyspnea on exertion. Eventually, the patient expired because of heart failure caused by progressive constrictive pericarditis. We suggest that acute purulent pericarditis should be considered in dialysis patients who develop fever and severe hypotension during HD, especially after known staphylococcal infections.

Performance of interferon- release assay in the diagnosis of tuberculous pericarditis: a meta-analysis

서현택,김윤성,강래형,옥혜성,변기섭,윤성훈,여혜주,이승은 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: Recently, there have been several articles investigated the diagnostic value of IGRA in the diagnosis of tuberculous pericarditis. IGRA has been reported that a high sensitivity and specificity in these articles. Thus, we conducted the present meta-analysis to comprehensively evaluate the overall diagnostic accuracy of IGRA upon tuberculous pericarditis. Methods: We conducted electronic English-language literature searches of MEDLINE via PubMed, Embase and Cochrane Library database from the earliest available date of indexing through May 31, 2017. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves parameters. Results: Across 8 studies (591 patients), the pooled sensitivity for IGRA methods was 0.92 (95% CI; 0.87-0.95) without heterogeneity (χ2=14.31 , p=0.05) and a pooled specificity of 0.88 (95% CI; 0.75-0.94) with heterogeneity (χ2=9.71, p= 0.21). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 17.5 (95% CI; 9.9-30.9) and negative likelihood ratio (LR-) of 0.08 (95% CI; 0.05-0.14). The pooled DOR was 214 (95% CI; 105-436). Conclusion: IGRA demonstrated good sensitivity and specificity for diagnosis of TB pericarditis. At present, the literature regarding remains the use of IGRA for diagnosis of TB pericarditis still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of IGRA prediction of TB pericarditis.

Acute Recurrent Pericarditis Accompanied by Graves’ Disease

구은희,Sung Min Kim,Sun Mi Park,Ji Won Park,Eun Kyoung Kim,Ga Yeon Lee,장성아,이상철,Yeon Hyeon Choe 대한심장학회 2012 Korean Circulation Journal Vol.42 No.6

The etiology of acute pericarditis is often thought to be autoimmune, and Graves’ disease has been reported in a few series to manifest as acute pericarditis. Since the etiology of recurrent pericarditis is known to be more associated with autoimmune causes, recurrent acute pericar-ditis may be a potential cardiovascular complication of Graves’ disease. We report a case of recurrent acute pericarditis that was presumed to be associated with Graves’ disease which was controlled after management of the problem of the thyroid.

혈액투석 중인 환자에서 발생한 투석-연관성 심낭염의 임상적 고찰

이재명 ( Jae Myoung Lee ),김진수 ( Jin Soo Kim ),김정권 ( Jung Kwon Kim ),양재원 ( Jae Won Yang ),김민수 ( Min Soo Kim ),한병근 ( Byoung Geun Han ),최승옥 ( Seung Ok Choi ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

배 경 : 말기신부전 환자에서 발생하는 심남염은 부적절한 투석, 감염, 부갑상선 호르몬 이상, 결체조직질환, 혈소판 기능손상, 심근경색, 투석시 사용되는 항용고제나 약제 그리고 면역학적 요소로 인한 순환 면역 복합체 및 보체 등과 연관되어 나타날 수 있으며, 요독성 심낭영의 발생 빈도는 약 20% 정도로 말기신부전 환자의 유병률과 사망률을 높이는 중요한 합병증의 하나로 알려져 있다. 일반적으로 심낭염의 원인과 심낭삼출책의 정도는 치료에 대한 반응과 예후에도 차이가 있으며 심낭삼출액의 진단과 추적관찰에는 심초음파촬영이 유용한 것으로 알려져 있다. 이에 저자들은 정기적 혈액투석 중 요독성 심낭염의 소견을 보여 심초음파를 시행한 환자의 임상 양상을 알아보고자 하였다. 방 법 :심초음파 검사상 요독성 심낭염이 의심된 환자 35예의 진료기록을 검토하여 심남 삼출량의 정도에 따라 미세소량군과 중등-대량군으로 나누어 두 군간의 진단 당시의 검사결과 및 심출 정도에 따른 임상적 특징을 비교하였다. 결 과 : 미세소량군과 중등-대량군은 각각 18예 (51.4%), 17예 (48.5%)이었고, 심장 탐포네이드는 후자에서 2예가 관찰되었다. 중등-대량군의 경우 미세소량군과 비교하여 요소감소율은 각각 24.3±21.2%와 42.9±20.0%으로 상대적으로 낮게 나타났으며 (p<0.05), 총 투석기간도 17.6±21.0개월과 3.6±8.3개월로 중등-대량군이 유의하게 긴 것으로 나타났다(p<0.05). 투석기간이 6개월 미만인 경우에 심낭염이 있는 경우가 총 16예 (45.7%)이었고. 12개월 이상인 경우에 모두 8예 (22.9%)가 중등-대량군으로써 미세소량군보다 많은 분포를 보였다. 미세소량군과 중등-대량군의 좌심실 직경은 이완기와 달리 수축기시에만 각각 3.84±1.1 ㎝와 4.8±0.7 ㎝을 보여 유의한 차이를 보였다.(p<0.05). 결 론 : 혈액투석 중인 환자의 심혈관계질환에 대한 추적검사 중 심비대의 소견이 있는 경우에 심초음파 검사는 심낭염과 심장의 기저질환 등을 감별할 수 있는 유용한 진단적 수단이 되며, 처음 투석을 시행하고 6개월내에 다수의 심낭염이 나타나므로 이에 대한 주의가 필요하고 총 투석기간이 1년 이상 되는 환자에서 심낭 삼출액의 양이 많은 것으로 나타나 심초음파 검사를 통한 심장기능에 대한 정확한 평가 및 투석 적절도에 대한 세심한 평가가 투석-연관성 심낭염의 합병증을 줄이는데 도움을 주리라 생각된다. Background : The accurate pathogenetic mechanism of dialysis associated pericarditis remain uncertain, but its clinical significance is very important from a therapeutic and prognostic point view. Clinical features of the disease weren`t reported well in Korea. So, we analyzed the clinical characteristics of the dialysis associated pericarditis. Methods : Thirty-five patients were included in this study. The study group was divided into two groups (a minimal group and moderate to large group) according to the amount of the pericardial effusion on echocardiogram. We reviewed and compared the clinical appearance, laboratory data and echocardiogram findings. Results : There were 18 cases (51,4%) of minimal amount pericardial effusion and 17 cases (48.5%) of moderate to large amount. Cardiac tamponade developed in 2 patients. There was a significant difference in urea reduction rate between minimal group (42±20 and moderate to large group (24.3±21.2%) (P<0.05). A time to pericardial effusion development from dialysis initiation was 3.6±8.3 months, 17.6 21.0 months, respectively and the difference showed statistical significance (p<0.05). The Left ventricular dimension at systole was 4.8±0.7 ㎝, 3.8±1.1 ㎝, respectively. This difference is statistically significant (p<0.05). In the minimal amount group, 16 (89.9%) cases were treated conservatively and 2 cases (10.1%) were treated surgically. In the moderate to large amount group, 10 cases (58.8%) were treated surgically. Conclusion : These results show that the dialysis associated pericarditis with moderate to large amount of pericardial effusion have lesser urea reduction rate, longer dialysis treatment period and require further surgical approach than minimal amount group. We suggest that the sufficient and adequate dialysis and the regular echocardiogra needed. This need is more eminent as the duration of dialysis become longer. It is possible to prevent the development of pericarditis and its complication.