本文报道了一名68岁男子的不太可能的情况,轻度下呼吸道感染,随后在没有结核病危险因素且结核病血清学阴性的情况下诊断为心包结核(TB)。在CT肺血管造影上偶然发现心包和胸腔积液,在超声心动图上看到少量心包积液,没有填塞。在他三个月的住院期间,病人很少非常不适,虽然没有治疗导致临床和生化症状的解决。后来恶化促使另一个超声心动图,发现了中等大小的心包积液,间隔弹跳,和新的区域壁运动异常。为了避免即将发生的心脏填塞,病人接受了心包切除术,这提供了结核病的组织诊断。心包结核是非常罕见的,特别是在结核病流行地区之外,虽然描述得很好。这个案子尤其值得注意,作为血清学,支气管冲洗,尽管Quantiferon试验呈阳性,但胸膜抽吸液对TB呈阴性。诊断仅在心包切除术后得到证实。患者随后接受了抗结核治疗,具有良好的临床反应。本案例重点介绍了调查和管理类似复杂场景的诊断挑战和策略,特别是在非地方性环境中。
This paper reports on the unlikely case of a 68-year-old man presenting with a non-resolving, mild lower respiratory tract infection, subsequently diagnosed with pericardial tuberculosis (TB) in the absence of TB risk factors and with negative TB serology. Pericardial and pleural effusions were found incidentally on CT pulmonary angiogram, with a small pericardial effusion without tamponade seen on the echocardiogram. During his three-month inpatient stay, the patient was rarely very unwell, though no treatment led to clinical and biochemical resolution of symptoms. Later deterioration prompted another echocardiogram, which found a moderate-sized pericardial effusion, septal bounce, and new regional wall motion abnormalities. To avert the impending cardiac tamponade, the patient underwent pericardiectomy, which provided a tissue diagnosis of TB. Pericardial TB is extremely uncommon, especially outside of TB endemic regions, though it is well described. This case is especially noteworthy, as serology, bronchial washings, and pleural aspirate had been negative for TB though a Quantiferon test was positive. The diagnosis was only confirmed after pericardiectomy. The patient was subsequently treated with anti-TB therapy, with a good clinical response. This case highlights diagnostic challenges and strategies for investigating and managing similar complex scenarios, particularly in non-endemic settings.