Is It an Intrapericardial Mass or a Localized Pericardial Effusion? A Case Report of Tuberculous Pericarditis Evaluated by Multimodal Imaging

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Tuberculous pericarditis with encapsulated pericardial effusion (n=1). Intervention: Multimodal imaging (TTE, TEE, contrast-enhanced ultrasound, enhanced CT), CT-guided puncture, and antituberculosis therapy (isoniazid, rifampin, pyrazinamide, ethambutol). Primary outcome: Definitive diagnosis and clinical resolution of tuberculous pericarditis.

Q: What does this research mean for the field?

Multimodal imaging combined with CT-guided puncture can identify Mycobacterium tuberculosis in atypical localized pericardial lesions mimicking cardiac neoplasms, enabling definitive diagnosis and curative antituberculosis therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Bingbing Liu; Yonghuai Wang; Fei Xia; Jun Yang; Chunyan Ma

doi:10.1002/jcu.24054

June 4, 2025Journal of Clinical UltrasoundOpen Access

Is It an Intrapericardial Mass or a Localized Pericardial Effusion? A Case Report of Tuberculous Pericarditis Evaluated by Multimodal Imaging

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Key result

Multimodal imaging with CT-guided puncture diagnoses rare tuberculous pericardial mass to guide curative therapy.

n=1

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Graphical abstract published by Journal of Clinical Ultrasound — Graphical abstract · Published by Journal of Clinical Ultrasound · CC BY-NC-ND

Key Points

To describe the diagnostic evaluation and successful management of an atypical presentation of tuberculous pericarditis masquerading as an intrapericardial mass.
Diagnostic workup of a patient with high fever and recurrent pericardial effusion whose initial etiology and genetic testing for tuberculosis were negative.
Application of multimodal imaging consisting of transthoracic echocardiography, transesophageal echocardiography, contrast-enhanced ultrasound, and contrast-enhanced computed tomography.
Echocardiography identified a low-echo lesion in the pericardial transverse sinus, and contrast-enhanced ultrasound demonstrated an absence of perfusion, effectively excluding a malignant vascular mass.
Computed tomography localized the lesion as a low-density fluid collection, and puncture fluid analysis confirmed viscous components positive for Mycobacterium tuberculosis.
Treatment with daily isoniazid (300 mg), rifampin (600 mg), pyrazinamide (1600 mg), and ethambutol (1100 mg) for 6 months, followed by rifampin, isoniazid, and ethambutol for 6 months, resolved symptoms without recurrence.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 35-year-old female presenting with recurrent fever, paroxysmal bilateral shoulder pain, mild chest tightness, dyspnea, and an intrapericardial mass-like localized pericardial effusion treated for 12 months.

I

Intervention

Multimodal imaging evaluation (transthoracic echocardiography, transesophageal echocardiography, contrast-enhanced ultrasound, and enhanced CT) followed by CT-guided puncture for etiological diagnosis (PCR and mNGS) and a 12-month oral antituberculosis treatment regimen (isoniazid 300 mg, rifampin 600 mg, pyrazinamide 1600 mg, and ethambutol 1100 mg daily for 6 months, followed by rifampin, isoniazid, and ethambutol for an additional 6 months).

O

Outcome

Definitive etiological diagnosis of tuberculous pericarditis with encapsulated pericardial effusion and clinical symptom resolution without recurrence.

Multimodal imaging combined with CT-guided puncture and metagenomic next-generation sequencing enables the definitive diagnosis of atypical tuberculous pericarditis presenting as a localized intrapericardial mass, allowing timely antituberculosis therapy before progression to constrictive pericarditis.

Limitations

Insufficient backing for the performance of relevant laboratory examinations to rule out non-infectious conditions such as rheumatic immune system disorders and tumors
Insufficient empirical support for alternative pathogenic examinations pertaining to the patient's bodily fluids

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Implication

May enable curative therapy for atypical pericardial lesions when routine TB tests are negative; leaves open prospective validation of this multimodal approach.

Abstract

Tuberculous pericarditis is often difficult to diagnose because of atypical symptoms and insufficient etiology examination. We present a case wherein the patient initially presented with a high fever accompanied by recurrent pericardial effusion. Notably, the etiology and genetic diagnosis of tuberculosis were negative. With the combined application of multimodal imaging techniques such as transthoracic echocardiography, transesophageal echocardiography, contrast-enhanced ultrasound and enhanced CT, clinical diagnosis and treatment can provide sufficient evidence to support tuberculous pericarditis. Following the definitive diagnosis, the patient received an adequate course of antituberculosis treatment, and the condition improved significantly, with no recurrence of symptoms.

Discussion

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Cite This Study

Liu et al. (2025) conducted a case report in Tuberculous pericarditis with encapsulated pericardial effusion (n=1). Multimodal imaging (TTE, TEE, contrast-enhanced ultrasound, enhanced CT), CT-guided puncture, and antituberculosis therapy (isoniazid, rifampin, pyrazinamide, ethambutol) was evaluated on Definitive diagnosis and clinical resolution of tuberculous pericarditis. Multimodal imaging and CT-guided puncture identified Mycobacterium tuberculosis complex in a 67 x 45 mm pericardial lesion, enabling curative 12-month antituberculosis therapy.

synapsesocial.com/papers/6a896749c29c9b72f7c11a27 https://doi.org/10.1002/jcu.24054

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Is It an Intrapericardial Mass or a Localized Pericardial Effusion? A Case Report of Tuberculous Pericarditis Evaluated by Multimodal Imaging

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Is It an Intrapericardial Mass or a Localized Pericardial Effusion? A Case Report of Tuberculous Pericarditis Evaluated by Multimodal Imaging

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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