Cardiac tuberculosis: TB of the endocardium

Tuberculosis involving the endocardium is extremely rare. The diagnosis is usually made during autopsy. Often there is involvement of other parts of the heart as well as other regions of the body. The infection is a result of direct extension from the myocardium or hematogenous spread. Two cases of disseminated tuberculosis with endocardial involvement are reported. In Case 1 miliary tuberculosis was diagnosed during life but the patient succumbed to extensive disease on the third hospital day. The patient in Case 2 presented with congestive cardiac failure and the possibility of tuberculosis was not suspected during life.

Sudden death due to myocardial tuberculosis

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Isolated interventricular septal tuberculoma causing complete heart block

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Late generalized tuberculosis: a clinical pathologic analysis and comparison of 100 cases in the preantibiotic and antibiotic eras

1. The clinical and pathologic findings in 100 patients with late generalized tuberculosis (LGT) are described and a comparison made between the findings occurring in the preantibiotic era with those in the early antibiotic period. The clinical presentation of LGT as seen in a general hospital has changed. Whereas, in the preantibiotic era, LGT was often the primary disease, occurring principally in young adults and frequently associated with pulmonary symptoms, in the antibiotic era, LGT commonly occurred together with and was frequently obscured by other diseases, often afflicted the elderly and was much less frequently accompanied by pulmonary symptoms. Symptoms related to extrapulmonary organ tuberculosis in this era were absent in 30% of patients. 2. Diagnostic difficulties in LGT arose because 20% of patients exhibited no constitutional symptoms prior to hospitalization, a history of tuberculosis often was lacking, fever curves and hematologic findings, with the exception of a left shift, commonly were non-specific, monocytosis frequently was absent, chest x-rays were non-diagnostic in about 50% of the cases, and anergy occured particularly in the elderly. 3. Caseous foci responsible for hematogenous spread generally derived from reactivated old caseous lesions located principally in the lungs, lymph nodes, bone, central nervous system, adrenals, and genito-urinary tract. Simultaneous reactivation of anatomically unrelated foci in multiple organs and lymph nodes occurred in 54% of cases. Although chronic pulmonary tuberculosis commonly was associated with LGT in the preantibiotic era, this association was uncommon in recent times. Chronic pulmonary tuberculosis served as the sole source for hematogenous dissemination infrequently and the pulmonary lesions responsible were acute. 5. Large caseous foci located in lymph nodes, bone, prostate gland, and central nervous system frequently occurred in the absence of clinical symptoms and therefore were undiagnosable. 6. The clinical course of LGT was often rapid, although histologic features indicated that the course in some patients was protracted or even episodic. 7. Miliary tubercles very frequently showed caseation and often they enlarged to cause progressive or complicated lesions. Chest x-rays and culture diagnoses were dependent on the formation of these complicated lesions. 8. Liver biopsy is recommended as a diagnostic procedure since 97% of patients exhibited granulomata in this organ. Of diagnostic importance is the fact that 90% of these granulomata exhibited caseous necrosis. Twenty-two percent of patients with liver granulomatas did not show tubercles in the bone marrow. 9. Multiple pathways rather than an exlcusive lymphangitic route were available for tubercle bacilli to gain access to the blood stream and cause hematogenous dissemination.

Tuberculous endocarditis: A report of 2 cases

Two patients with tuberculous endocarditis are described. In one patient the condition developed on a mitral valve prosthesis and in the other in thrombus adherent to a ventriculo-atrial shunt.

Tuberculous pericarditis. A review of 100 cases

A retrospective survey of 100 Black patients with presumed tuberculous paricarditis showed that 82 presented with pericardial effusion while 18 had constrictive pericarditis. The mortality rate was 17%. Of the 82 patients with pericardial effusion, 15 developed 'constricting pericarditis' within 4 months; 12 required pericardiectomy. Sixteen patients died of cardiac tamponade; the effusion had been confirmed by a radio-isotope heart pool scan but had not been aspirated. This emphasizes the need for early and repeated pericardial aspiration. The fate of 38 rural patients with pericardial effusion was not known. Of the 18 patients with constrictive pericarditis, 7 underwent pericardiectomy, while 3 refused operation.

Rupture of a tuberculous pseudoaneurysm of the innominate artery into the trachea and esophagus: report of a case and review of the literature

Spontaneous rupture of a tuberculous pseudoaneurysm of the innominate artery, undiagnosed until necropsy, occurred simultaneously into the trachea and the esophagus in a patient receiving anti-tuberculosis chemotherapy. This is the first reported instance of a tuberculous innominate artery aneurysm, the third tuberculous aneurysm with rupture into the trachea, the sixth into the esophagus, and the first with rupture into both structures. A review of the literature relating to tuberculous aneurysms of the major arteries is provided.

[Coronary embolism in the medico-legal autopsy material (author's transl)]

The author discusses the problem of diagnosis and evaluation of coronary embolism (CL). He presents four cases of his own observation, including histological examinations and a review of the pertinent literature. The following facts are necessary to make the diagnosis of CE: 1. An embolus consisting of foreign elements like tumor-cells, suture material or similar things. 2. Dilatation of the arterial lumen where the embolus is found. 3. No adherence between the embolus and the arterial wall. 4. Normal consistence of the arterial wall. 5. Knowledge of the source of the embolus. 6. Histomorphological conformity of the source of the embolus and the embolus itself. The mechanisms of flow and the interrelation between trauma and CE which are often difficult to judge in forensic medicine are discussed.

[Complete atrio-ventricular block caused by tuberculoma of the inter-atrial septum. Histological analysis]

A syndrome of obstacle to the outflow of the left ventricle was found in a woman with atrio-ventricular block with narrow ventricular complexes. A tuberculoma of the intar-atrial septum was responsible both for the obstacle to left ventricular ejection and for the block which was found to be proximal on microscopic examination.

Case of post-primary tuberculosis and massive haematemesis

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