藤井 信一郎¹, 束村 正¹, 小出 司郎策²

Shinichiro FUJII¹, Tadashi TSUKAMURA¹, Sirosaku KOIDE²

¹秦野赤十字病院循環器科, ²東海大学第1外科

¹Department of Cardiology, Hatano Red Cross Hospital, ²The First Department of Surgery, Tokai Uniersity School of Medicine

キーワード : Tuberculous pericarditis, Cardiac tamponade, Constrictive pericarditis Echocardiogram

We report herein on a 46-year-old female patient. On admission, echocardiogram demonstrated evidence of right atrial collapse during the systole and right ventricular collapse during the diastole. These collapses are the most reliable sign of cardiac tamponade. Two weeks after pericardial drainage, slowly biphasic septal motion during the diastole and pericardial thickening were observed. This slowly biphasic septal motion during the diastole may be the echocardiographic finding in the early stage of constrictive pericarditis. Flat posterior wall motion during the diastole was noted 4 weeks later, and early diastolic and atrial systolic notch of ventricular septum, 6 weeks later. At this stage, the flow velocity pattern of left ventricular filling and hepatic vein were consistent with constrictive pericarditis, showing a disturbance of cardiac filling. As mycobacter tuberculosis developed from pericardial fluid at the same time, the patient received antituberculosis chemotheraphy despite a state of hemodynamic constriction. Four months after medication, persistant pericardial effusion, abnormal motion of ventricular septum and left ventricular posterior wall disappered. It is quite plausible that chemotherapy might improve echocardiographic and Doppler data of constrictive pericarditis, if pericardial effusin persists inside of a thikening pericardium. Tuberculous pericarditis could also show various cardiac findings similar to those in our case, therefore it is of value to study this disease from the early stage after admission by echocardiogram.