Acute Primary Tuberculous Pericarditis

急性原發性結核心包膜炎

金憲國(Hsien-Kuo Chin) ； 張一方(Yee-Phoung Chang) ； 趙家聲(Chia-Shen Chao)

《Acta Cardiologica Sinica》 23卷1期 (2007/03) Pp. 56-61

摘要

急性原發性結核心包膜炎是一十分罕見但卻致命的一種狀況，它通常導致侷限性心包膜炎進而造成舒張性心衰竭。我們報告一位77歲男性在住院前三個月因冠心症合併心衰竭接受左前降支支架置放術。後因氣喘而到本院求診，要求進行冠狀動脈繞道手術。心導管攝影顯示除左前降支之支架外無明顯病兆。住院後反覆有兩側助膜積水，積水之所有結核檢查皆呈陰性。3週後於心臟超音波檢查發現心包膜有增厚情形且合併大量心包膜液，因為造成心包填塞而從劍突施予緊急心包膜切開術。經組織病理診斷為急性原發性結核心包膜炎，我們給予抗結核菌藥物合併類固醇輔助治療後病情明顯好轉並於幾天後出院。病患於一個月後因侷限性心包膜炎而施予心包膜截除術。病患在九個月的抗結核藥物治療後，追蹤至今滿一年仍保持良好狀態。

關鍵字

心包填塞 ； 類固醇 ； 心包膜截除術 ； 原發性結核心包膜炎

並列摘要

Acute primary tuberculous (TB) pericarditis is a rare but life-threatening condition. It may lead to diastolic heart failure in constrictive pericarditis. A 77-year-old man suffered from exertional dyspnea for 3 weeks. He had received percutaneous transluminal coronary angioplasty (PTCA) with stent for left anterior descending artery lesion 3 weeks prior to this admission. As dyspnea on exertion persisted, he was admitted to our hospital for possible coronary arterial bypass grafting. No significant in-stent restenosis was found during recatheterization. Meanwhile, bilateral pleural effusions were found, but they were negative for TB cultures and polymerase chain reaction (PCR). Thickening of pericardium with large amount of pericardial effusion was noted during echocardiographic examination 3 weeks after admission. Emergent pericardiotomy was done for cardiac tamponade and biopsy. Acute primary TB pericarditis was diagnosed and antituberculous chemotherapy plus adjuvant corticosteroid treatment were given. The patient was discharged 2 weeks later in fair condition. Unfortunately, one month later he was readmitted due to constrictive pericarditis. Pericardiectomy was done. After a full course of anti-TB therapy for 9 months, the patient kept well after follow-up for one year.

並列關鍵字

Cardiac tamponade ； Corticosteroid ； Pericardiectomy ； Primary tuberculous pericarditis