Echocardiography in a case of acute tuberculous pericarditis which progressed to constrictive pericarditis

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.