Cardiac tuberculosis with multiple intracardiac masses: a case report

Right atrial tuberculoma enclosed by thrombus

Right atrial tuberculoma (RAT) are an exceedingly rare heart mass often caused by primary pulmonary tuberculosis (TB) in patients infected with human immunodeficiency virus (HIV). In HIV patients, the right atrium is not only a suitable location for tuberculoma formation, but also has a tendency for thrombus formation due to the thrombophilic state of HIV and the destructive effect of the HIV virus on the endothelial surface of the right atrium and subsequent thrombus formation. These masses can simply be detected by transthoracic echocardiography (TEE), but their differentiation from other cardiac pathologies requires histological examination. Herein, using a positive polymerase chain reaction test, we report a case of a previously diagnosed HIV-positive 24-year-old man who presented with a right atrial thrombus, dyspnea, and pleural effusion. Final histological examination identified the right atrial thrombus as a tuberculoma. The patient underwent open heart surgery to remove the mass and received prolonged postoperative TB therapy together with HIV drugs. Three-month follow-up showed some remaining dyspnea and lower extremity edema; however, TEE showed no recurrence of the RAT or thrombus.

Multiple Intracardiac Masses Involving 3 Chambers of the Heart

•A 42-year-old man presented with multiple cardiac masses. •Metastatic disease is far more prevalent than primary cardiac tumors. •Multimodality imaging aids in the diagnostic and management strategy. •Optimal treatment of large, chronic intracardiac thrombi needs to be refined.

Thoracic Cardiovascular Complications of Tuberculosis

ABSTRACT

Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.

Management of patients with myocardial tuberculosis: A case series

BACKGROUND

Myocardial Tuberculosis (MT) is exceedingly rare. We aimed to report on myocardial involvement in tuberculosis (TB).

METHODS

All adult patients admitted in a department of Internal Medicine over an 8-year period with microbiologically proven MT were retrospectively reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records.

RESULTS

Six patients (4 women, 37.6 [21.3-62.1] years) with MT were identified. MT included cardiac mass (n = 1), coronaritis (n = 1), left ventricle spontaneous rupture (n = 1) and myocarditis (n = 3). Pericardial effusion was associated with myocardial involvement in 2 cases. Four patients presented with acute heart failure. CRP serum level was high in all cases. The mean delay between the first symptoms and TB diagnosis was of 6 [1-44] months. The time from admission to diagnosis was of 18 (9-28) days. No patient had human immunodeficiency virus infection. Fluorodeoxyglucose - positron emission tomography (FDG-PET) detected extra-cardiac asymptomatic Mycobacterium tuberculosis infection localization and guided biopsy in 5 cases. As compared to TB patients without cardiac involvement, patients with MT were younger and more frequently women. All patients received antituberculosis therapy for 7.5 to 12 months associated with steroids for at least 6 weeks. Cardiac surgery was required in all but one patient. No patient died over a median follow-up of 1.2 [0.2-4.4] years.

CONCLUSION

Our study emphasizes the clinical spectrum of life-threatening MT. Early diagnosis using FDG-PET imaging to target biopsy in extra-cardiac tissues and combined treatment strategy associating antituberculosis therapy, corticosteroids and surgery prevent complications and death.

Diagnostic challenges in a patient with myocardial tuberculoma: A case report

INTRODUCTION

Tuberculosis can affect any organ of the body, including the heart.

PRESENTATION OF CASE

An 18-year old woman presented with a multifocal tuberculosis infection involving abdominal lymph nodes, a sternotomy wound, an abscess of the abdominal wall and most notably a myocardial tuberculoma. Establishing the diagnosis of the myocardial tuberculoma was challenging mainly due to the location within the heart. Initially a diagnostic percutaneous femoral vascular catheter guided biopsy of the right atrial mass was performed, but later open surgery involving median sternotomy was needed. The patient recovered fully after surgery and nine months treatment with anti-tuberculosis drugs.

DISCUSSION

The optimal length of treatment for myocardial tuberculoma is unknown. Medical treatment for six months might be enough regardless whether surgery is performed or not.

CONCLUSION

Myocardial tuberculoma requires culture from the infected tissue for confirmed diagnosis and might be successfully treated with anti-tuberculosis drugs only. Indications for surgery include uncertain diagnosis, poor response to medical treatment or cardiac complications.

Unusual presentation of a young man with disseminated tuberculosis and right ventricular mass

We report a 22-year-old man who presented to the emergency department with worsening shortness of breath and chronic fever for 2 months. Physical examination was unremarkable except for raised jugular venous pressure and palpable liver. Echocardiogram showed a large right ventricular mass causing obstruction at tricuspid valve. A subsequent chest CT scan confirmed the presence of a large mass in the right ventricle. There were multiple enlarged lymph nodes and consolidation in the right upper lobe. Diagnosis of disseminated tuberculosis (TB) was made and later confirmed by histopathology of lymph node biopsy along with positive sputum culture for acid-fast bacilli. Remarkable recovery was observed on antituberculous therapy, with complete disappearance of the cardiac mass on echocardiogram, at 1-year follow-up. Although unusual and rare, myocardial involvement as a large mass should be kept in mind while treating patients with disseminated TB.

Double papillary fibroelastoma: beautiful, innocent flowers in the left heart

Papillary fibroelastoma is a rare, benign tumor, and multiple papillary fibroelastomas are even more uncommon. In an asymptomatic patient scheduled for carotid endarterectomy, transthoracic echocardiography discovered a fibroelastoma on the mitral valve. Then, transesophageal echocardiography showed another fibroelastoma on the aortic valve. Because he also needed a right coronary artery bypass, the patient underwent surgical excision of both masses. Fibroelastomas are not always as innocent as they seem, and surgical excision is necessary because of their potential for systemic or coronary embolization. Transoesophageal echocardiography may improve the diagnosis of multiple papillary fibroelastomas.