Definition/General
Introduction:
Tuberculous pericarditis is infection of pericardium by Mycobacterium tuberculosis
Accounts for 1-8% of TB cases
Higher prevalence in HIV-positive patients
May progress to constrictive pericarditis
High mortality if untreated.
Origin:
Results from hematogenous spread
Direct extension from mediastinal lymph nodes
Reactivation of latent pericardial foci.
Classification:
Stages: Acute fibrinous
Effusive
Absorptive
Constrictive.
Epidemiology:
Endemic in developing countries
Male predominance
HIV co-infection in 50-70% cases.
Clinical Features
Presentation:
Chest pain
Fever with night sweats
Dyspnea
Weight loss
Pericardial friction rub.
Symptoms:
Chest pain (90% cases)
Fever (80% cases)
Dyspnea (70% cases)
Cough (60% cases)
Night sweats (75% cases).
Risk Factors:
HIV infection
Immunocompromised state
Pulmonary tuberculosis
Endemic area residence.
Screening:
Tuberculin skin test
Chest X-ray
Pericardiocentesis
ADA levels.
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Microscopic Description
Histological Features:
Lymphocytic predominance (>80%)
Epithelioid cells may be present
Chronic inflammatory cells
AFB rarely seen (10-20%).
Cellular Characteristics:
Small mature lymphocytes
Activated lymphocytes
Plasma cells
Epithelioid cells (when present).
Architectural Patterns:
Dispersed lymphocytes
Epithelioid clusters
Granulomatous inflammation.
Grading Criteria:
ADA levels >40 U/L
PCR positivity
Epithelioid cells diagnostic.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Pericardial fluid, volume [X] mL, straw-colored
Cell Differential
Lymphocytes: [X]% (>80%), Neutrophils: [X]%, Macrophages: [X]%
Additional Studies
ADA level: [X] U/L (>40 U/L suggestive of TB)
Final Diagnosis
Pericardial fluid consistent with tuberculous pericarditis