The role of chest radiography in diagnosing patients with tuberculous pericarditis
Date
2005-04
Authors
Reuter, Helmuth
Burgess, Lesley J.
Doubell, Anton F.
Journal Title
Journal ISSN
Volume Title
Publisher
Clinics Cardiv Publishing
Abstract
Aim: To describe the abnormalities on chest X-ray
(CXR) in patients presenting with tuberculous pericardial
effusions.
Methods: One hundred and seventy patients presented
to Tygerberg Hospital with large pericardial effusions
(epi-pericardial separation > 10 mm). All patients had
a diagnostic work-up, which included CXR, ECG,
two-dimensional echocardiography and HIV serology.
Echocardiography was followed by pericardiocentesis
and drainage. Pericardial fluid was analysed for adenosine
deaminase (ADA), Ziehl Neelsen (ZN) stain, bacterial
and mycobacterial cultures. Sputum was sent for
ZN stain and mycobacterial cultures. Tuberculous pericardial
effusions were diagnosed according to predetermined
criteria.
Results: The diagnosis of tuberculous pericarditis was
made in 53% (n = 90) of patients with pericardial
effusions. Forty-one of the subjects (45.5%) were HIV
positive. All patients had an enlarged cardiac silhouette
and in the majority of cases, the cardiac shadow was
globular with distinct margins. The cardiothoracic ratio
(CTR) exceeded 0.55 in all patients. The amount of
fluid drained correlated with the radiographic finding
of cardiac enlargement.
Conclusion: In developing countries where TB is very
prevalent, CXR plays an important role in the identification
of large pericardial effusions. Although sonography
will still be required for a definite diagnosis, the results
of this study show that CXR is a useful screening tool.
Description
The original publication is available at http://www.cvja.co.za/
Keywords
Radiography, Tuberculous pericarditis -- Diagnosis
Citation
Reuter, H., Burgess, L.J. & Doubell, A.F. 2005. The role of chest radiography in diagnosing patients with tuberculous pericarditis. Cardiovascular Journal of South Africa, 16(2):108-111.