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(Circulation. 2008;117:984-986.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Cardiac Tuberculoma

Mohamed Jeilan, BM, MRCP; Matthias Schmitt, MD, PhD; Gerry McCann, BSc, MD, MRCP; Joan Davies, PhD, FRCP; Joseph Leverment, MB, ChB, FRCP; Derek Chin, MB, BS, FRCP

From the Departments of Cardiology (M.J., M.S., G.M., J.D., D.C.) and Cardiothoracic Surgery (J.L.), Glenfield Hospital, Leicester, UK.

Correspondence to Mohamed Jeilan, Department of Cardiology, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK. E-mail jokumali@hotmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 43-year–old man with a 6-month history of cough, dyspnea, nocturnal sweats, and weight loss was reviewed in the clinic. Clinical examination revealed cervical lymphadenopathy and indicated constrictive physiology. Initial tests, including chest radiography, sputum examination, QuantiFERON-TB Gold test, and lymph node biopsy, were unyielding. HIV serology was nonreactive.

Cardiac magnetic resonance imaging (Figure 1A and 1B) demonstrated extensive tumor infiltration affecting the endocardium, myocardium, and pericardium. Transesophageal echocardiography–guided endomyocardial biopsy (Figure 2) of the tumor revealed mixed inflammatory cells with a vaguely granulomatous appearance (not shown). A pericardial biopsy via limited thoracotomy confirmed multiple centrally caseating granulomata (Figure 3). Antituberculous therapy was begun with symptom resolution. On follow-up, the patient was clinically improved. Repeat magnetic resonance imaging (Figure 4A and 4B) performed 8 months after therapy was begun confirmed almost complete disappearance of the left ventricle–encasing mass and a marked reduction in the size of the right atrial mass.

View larger version (97K):   Figure 1. Bright-blood (A) and black-blood (B) magnetic resonance images at the midventricular level. Note the tumor invasion of the lateral left ventricular wall, multiple nodular areas at the apex, and a large right atrium mass (arrow). This mass has a cross-sectional area of 9 cm2. The heart is literally "boxed in" and almost completely encased by tumor, with dense pericardial thickening (up to 8 mm) giving rise to constrictive physiology as seen on cine magnetic resonance imaging.

View larger version (77K):   Figure 2. Transesophageal echocardiography bicaval view. Note the middensity mass in the right . . . [Full Text of this Article]