RESUMO
La tuberculosis pericárdica es una manifestación poco frecuente de la tuberculosis extrapulmonar. Se presenta de manera insidiosa e inespecífica, lo que dificulta el diagnóstico, retrasa el tratamiento, y lleva a complicaciones graves, como el derrame pericárdico con signos de taponamiento cardíaco o pericarditis constrictiva. Se describe el caso de una paciente femenina de 18 años, embarazada, con antecedente de contacto estrecho con familiar con tuberculosis pulmonar, que consultó al servicio de urgencias por disnea. Entre los estudios solicitados, el ecocardiograma evidenció la presencia de un derrame pericárdico con compresión de cavidades, por lo que requirió pericardiocentesis. El cultivo del líquido pericárdico informó Mycobacterium tuberculosis y se inició trata miento antituberculosis y corticoides. Evolucionó con recurrencia del derrame a pesar de tratamiento médico adecuado y realización de ventana pericárdica.
Pericardial tuberculosis (TBP) is a rare manifestation of extrapulmonary tuberculosis (TB). It presents insidiously and nonspecifically, making diagnosis difficult and delaying treatment, leading to serious complications such as pericardial effusion with signs of cardiac tamponade or constrictive pericarditis. The case of an 18-year-old female patient, pregnant, with a history of close contact with a relative with pulmonary TB is described; she consulted the Emergency Service for dyspnea. Among the studies requested, the echocardiogram showed pericardial effusion with compression of cavities, requiring pericardiocentesis. Pericardial fluid culture revealed Mycobacterium tuberculosis and antituberculous treat ment plus corticosteroids were started. It evolved with a recurrence of effusion despite adequate medical treatment and the performance of a pericardial window.
Assuntos
FemininoRESUMO
The utility of the adenosine deaminase (ADA) assay in the diagnosis of patients with pleural tuberculosis (TB) and human immunodeficiency virus (HIV) infection is controversial. Forty-eight HIV positive patients with pleural effusion were evaluated; ADA assay was obtained in forty-three of them. Twenty-five patients presented diagnosis of TB. Patients with diagnosis of TB showed a median value of ADA of 70 IU/L (interquartile range (IQR) 41â»89) and the non-TB group a median of 27.5 IU/L (IQR 13.5â»52). Patients with diagnosis of TB had a median cluster of differentiation 4 (CD4) count of 174 (IQR 86â»274) and the non-TB group had a median of 134 (IQR 71â»371). Receiver operating characteristic curve was performed with an area under the curve of 0.79. The best cut-off obtained was 35 IU/L with a sensibility of 80% and a specificity of 66%. There was no correlation between CD4 lymphocytes count and the value of ADA in the TB patient group.
RESUMO
El sarcoma de la arteria pulmonar es una patología rara y de pronóstico letal. Se desconoce su etiología, pero con mayor frecuencia afecta al tronco de la arteria pulmonar y a sus ramas principales. Los estudios complementarios mediante resonancia magnética con gadolinio y tomografía por emisión de positrones son de utilidad para orientar el diagnóstico, pero este sólo se puede establecer al realizar un estudio histológico. Presentamos este caso dada la baja incidencia y su importancia para el diagnóstico diferencial del tromboembolismo pulmonar.
Pulmonary artery sarcoma is a rare tumor with lethal prognosis. Its etiology is unknown; most frequently the pulmonary trunk and its main branches are affected. Magnetic resonance imaging with gadolinium and positron emission tomography are complementary studies that can guide the diagnosis, but this can only be established with the histological study. We present this case because of the low incidence and its importance in the differential diagnosis of pulmonary thromboembolism.