CLINICALLY PRIMARY TUBERCULOUS PERICARDITIS

Abstract

The "clinically primary" type of tuberculous pericarditis is that in which, at the onset of symptoms, there are no clinically demonstrable active tuberculous lesions elsewhere in the body, although at some later date active foci may become demonstrable in other organs. 50 cases were collected from the literature, to which the authors added 3 of their own. In the 3 cases cited in detail important ob- servations include: (a) relatively large tuberculous pericar-dial effusion may be tolerated over considerable time (2 yrs.); (b) induced pneumopericardium is helpful in diagnosis and possibly in treatment; (c) in the presence of effusion the skin test may be negative to 1 mg. of O.T.; (d) failure to demonstrate the tubercle bacillus in the pericardial fluid does not preclude the diagnosis. In an analysis of clinical findings, sufficient data were available in only 37 of the cases. They were analyzed as to age, sex, race, symptoms and signs, laboratory findings, duration of illness and outcome. The diagnosis should be seriously considered when: (a) there are symptoms of unexplained fever, shortness of breath, edema, cough, weakness and chest pain; (b) there is evidence of pericardial involvement, viz., friction rub, effusion and characteristic abnormalities in the roentgenogram; (c) these findings are present in a Negro [male] over 30 yrs. of age. Failure to demonstrate the tubercle bacillus does not necessarily rule out the clinical diagnosis, since almost half of the cases analyzed required post mortem confirmation. Most cases terminate fatally within a year.