Tuberculosis of the Heart: A Diagnostic Challenge

Figures

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  Figure 1. (A) A 35-year-old male with a recent history of treated tuberculous pericarditis for six months had CMR for ventricular tachycardia. 2CH T2w STIR pictures demonstrate increased epicardial and transmural signals in the inferior wall (arrows). (B) A 35-year-old male with a recent history of treated tuberculous pericarditis for six months had CMR for ventricular tachycardia. 4CH T2w STIR pictures demonstrate irregular thickening of the pericardium (small arrows) with the increased transmural signal of the mid-lateral wall (thick arrow).

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  Figure 2. (A) A 35-year-old male with a recent history of treated tuberculous pericarditis for six months had CMR for ventricular tachycardia. Short axis mid myocardial slice, late enhancement images, shows subepicardial anterolateral (notched arrow), mesocardial mid and inferior septal (white arrow), anterior and posterior RV insertion points (curve arrow) with thickened pericardium and epicardial fat enhancement (thin arrows). Enlarged AL papillary muscle (arrowhead). (B) A 35-year-old male with a recent history of treated tuberculous pericarditis for six months had CMR for ventricular tachycardia. Short axis mid myocardial slice late enhancement images show all the features of (A) and asymmetrical enlargement of the AL papillary muscle (arrow). (C) A 35-year-old male with a recent history of treated tuberculous pericarditis for six months had CMR for ventricular tachycardia. Short axis mid myocardial slice late enhancement images show the RV lateral and inferior wall (arrow), superior and inferior insertion (white arrow) with epicardial fat enhancement (thin arrows). PM papillary muscle is with central enhancement (arrowhead).

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  Figure 3. A 35-year-old male with a recent history of treated tuberculous pericarditis for six months had CMR for ventricular tachycardia. 4 CH, late enhancement images, shows RV free wall (epicardial and transmural thin arrows), inferior septal (transmural- thick Arrow), lateral wall LV (transmural-thick arrow), and interatrial septum (thin arrow) enhancement.

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  Figure 4. A 35-year-old male with a recent history of treated tuberculous pericarditis for six months had CMR for ventricular tachycardia. A native T1 map of 1132 ± 178 (Figure 4) and ECV of 25 ± 8%.

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  Figure 5. T2W dark-blood coronal MRI image shows diffuse myopericardial thickening. The thickening is hypointense on T2W images and is causing attenuation of the proximal SVC (arrow). The image was adapted from [53].

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  Figure 6. Cardiac magnetic resonance images. (a,b) Axial T1-weighted images showing isointense masses (arrows) along the anterior right atrium (*), right ventricular outflow tract (#), and along both ventricles (+ indicates left ventricle). (c) Short axis T2-weighted image showing that the lesions are mildly hyperintense. (d) Steady-state free precession image revealing the infiltrative nature of the lesion along the left ventricle. The delayed enhanced short-axis image (e) shows heterogeneous enhancement of the mass. The image was adapted from [47].

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  Figure 7. (A) Cardiac magnetic resonance (CMR) shows multifocal subepicardial to mid-myocardial linear enhancement along the right ventricular insertion site, mid-anterolateral, and inferior segments (arrows) with corresponding focal myocardial edema. (B) Fused cardiac positron emission tomography CMR shows patchy areas of increased 18F-flurodeoxyglycose (FDG) uptake in the apical to mid-anterolateral, mid-to-basal anteroseptal at the right ventricular insertion site, and mildly increased FDG uptake in the apical inferior segments of the left ventricular myocardium corresponding to the regions of myocardial enhancement seen on CMR. (C,D) T2 black blood image showing T2 hyperintense changes in the left ventricular myocardium. The image was adapted from [61].