The Clinical Course of Tuberculous Pericarditis in Immunocompetent Hosts Based on Serial Echocardiography

Figures

• 

  Figure 1. Initial transthoracic echocardiography. (A) Pericardial effusion without constriction. Large amount of pericardial effusion was noticed (bidirectional arrow). The septal mitral annulus early diastolic velocity (septal e′) was 0.049 m/s (closed arrow). The lateral mitral annulus early diastolic velocity (lateral e′) was 0.078 m/s (open arrow). There was no diastolic flow reversal of the HV. (B) Pericardial effusion with constriction. Small amount of pericardial effusion was observed with pericardial thickening. The septal e′ (0.082 m/s) was higher than the lateral e′ (0.070 m/s). Expiratory diastolic flow reversal of HV was noticed (open arrowhead). (C) Constrictive pericarditis without pericardial effusion. Pericardial thickening was seen (closed arrowhead). The septal e′ (0.164 m/s) was higher than the lateral e′ (0.104 m/s). And also expiratory diastolic flow reversal of HV was noticed (open arrowhead). HV = hepatic vein.

• 

  Figure 2. Proportion of constrictive pericarditis over time. The proportion of patients with constriction decreased through the time. At initial diagnosis, 22 patients (44%) had constrictive pericarditis. After 1 month, the number of patients with constrictive pericarditis was reduced to 12 (27.3%) among 44 patients who underwent echocardiography. Six patients (12.5%) had constrictive pericarditis at 3 months and 5 patients (10%) remained chronic constrictive pericarditis at the end of 6 months for follow-up.

• 

  Figure 3. Clinical course of tuberculous pericarditis. The numbers in blue filled boxes mean the number of patients with constriction at that time. And the numbers in white boxes indicate the number of patients without constriction. Missing data is denoted by M (the number of patients). After 6 months of treatment, residual constrictive pericarditis developed in 4 patients (18.2%) among the 22 patients who initially presented constrictive pericarditis. However, only 1 patient developed residual constrictive pericarditis (3.6%) among 28 patients who initially presented effusion without constriction.

• 

  Figure 4. Resolution of constrictive pericarditis. (A) Initial echocardiography showed constrictive pericarditis with pericardial thickening (closed arrowhead). The septal mitral annulus early diastolic velocity (septal e′) was 0.136 m/s (closed arrow). The septal e′ was higher than the lateral e′ (0.116 m/s, open arrow). Expiratory diastolic flow reversal of the HV was observed dominantly (open arrowhead). In the M mode, ventricular interdependence was prominent. (B) After 6 months, the patients repeated echocardiography. Constrictive pericarditis was resolved. The septal e′(closed arrow) was 0.075 m/s which was lower than the lateral e′ of 0.120 m/s(open arrow). Expiratory diastolic flow reversal of HV was not observed. And also, ventricular interdependence disappeared. HV = hepatic vein.

• 

  Figure 5. Echocardiographic parameters for constriction over time. Ventricular interdependence was the initial parameter of improvement. Septal bouncing and pericardial thickening still remained even after constriction improved. HV = hepatic vein; IVC = inferior vena cava.