Tuberculous pericarditis pathophysiology: Difference between revisions
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=== Pathogenesis === | === Pathogenesis === | ||
* Hematogenous or lymphatic spread of mycobacterium tuberculosis to the pericardium | * Hematogenous or lymphatic spread of mycobacterium tuberculosis to the pericardium.<ref name="pmid18610109">{{cite journal| author=Peel AA| title=TUBERCULOUS PERICARDITIS. | journal=Br Heart J | year= 1948 | volume= 10 | issue= 3 | pages= 195-207 | pmid=18610109 | doi= | pmc=PMC481044 | url= }} </ref><ref name="pmid4050698">{{cite journal| author=Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J| title=Primary acute pericardial disease: a prospective series of 231 consecutive patients. | journal=Am J Cardiol | year= 1985 | volume= 56 | issue= 10 | pages= 623-30 | pmid=4050698 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4050698 }} </ref><ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref><ref name="pmid14749455">{{cite journal| author=Sagristà-Sauleda J, Angel J, Sánchez A, Permanyer-Miralda G, Soler-Soler J| title=Effusive-constrictive pericarditis. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 5 | pages= 469-75 | pmid=14749455 | doi=10.1056/NEJMoa035630 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14749455 }} </ref> | ||
* This causes acute inflammation of the [[pericardium]]. | |||
*We may have polymorphonuclear ([[PMN]]) and leukocytes infiltration in the pericardium. | |||
*Pericardial vascularization may happen as well. | |||
*This may lead to [[pericardial effusion]] and fibrinous changes of the pericardium. | |||
*[[Effusive constrictive pericarditis]] may be seen in some patients. | |||
*The visceral pericardium thickens with [[fibrin]] deposition (changes of [[constrictive pericarditis]]). | |||
*There are four pathologic stages of involvement: | |||
:'''Stage 1:''' Presence of diffuse [[fibrin]] deposition, [[granulomas]] and abundant [[mycobacterium]] | :'''Stage 1:''' Presence of diffuse [[fibrin]] deposition, [[granulomas]] and abundant [[mycobacterium]] | ||
| Line 20: | Line 26: | ||
:'''Stage 4:''' Development of [[constrictive pericarditis]]. The pericardial space is obliterated by dense adhesions with marked thickening of [[parietal]] layer and replacement of [[granulomas]] by fibrous tissue. | :'''Stage 4:''' Development of [[constrictive pericarditis]]. The pericardial space is obliterated by dense adhesions with marked thickening of [[parietal]] layer and replacement of [[granulomas]] by fibrous tissue. | ||
==Genetics== | ==Genetics== | ||
The development of tuberculous pericarditis is not the result of any genetic mutation. | |||
== Associated Conditions == | == Associated Conditions == | ||
Conditions associated with tuberculous pericarditis include: | |||
* Pulmonary TB | |||
* HIV | |||
* | |||
==Gross Pathology Images== | ==Gross Pathology Images== | ||
Revision as of 16:25, 16 December 2019
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Tuberculous pericarditis Microchapters |
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Differentiating Tuberculous pericarditis from other Diseases |
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Tuberculous pericarditis pathophysiology On the Web |
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Risk calculators and risk factors for Tuberculous pericarditis pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Pathophysiology
Pathogenesis
- Hematogenous or lymphatic spread of mycobacterium tuberculosis to the pericardium.[1][2][3][4]
- This causes acute inflammation of the pericardium.
- We may have polymorphonuclear (PMN) and leukocytes infiltration in the pericardium.
- Pericardial vascularization may happen as well.
- This may lead to pericardial effusion and fibrinous changes of the pericardium.
- Effusive constrictive pericarditis may be seen in some patients.
- The visceral pericardium thickens with fibrin deposition (changes of constrictive pericarditis).
- There are four pathologic stages of involvement:
- Stage 1: Presence of diffuse fibrin deposition, granulomas and abundant mycobacterium
- Stage 2: Development of serous or serosanguineous pericardial effusion with a predominantly lymphocytic exudate with monocytes and foam cells
- Stage 3: Absorption of the effusion with organization of granulomatous caseation and thickening of pericardium secondary to deposition of fibrin and collagen.
- Stage 4: Development of constrictive pericarditis. The pericardial space is obliterated by dense adhesions with marked thickening of parietal layer and replacement of granulomas by fibrous tissue.
Genetics
The development of tuberculous pericarditis is not the result of any genetic mutation.
Associated Conditions
Conditions associated with tuberculous pericarditis include:
- Pulmonary TB
- HIV
Gross Pathology Images
-
Tuberculous pericarditis: Gross, natural color, shaggy hemorrhagic exudate. This case is much more hemorrhagic than the typical tuberculous pericarditis.
Microscopic Pathology Images
-
Tuberculous pericarditis. -
Tuberculous pericarditis. -
Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen.
-
Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen. -
Tuberculous pericarditis: Micro med mag, H&E, a typical lesion.
References
- ↑ Peel AA (1948). "TUBERCULOUS PERICARDITIS". Br Heart J. 10 (3): 195–207. PMC 481044. PMID 18610109.
- ↑ Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J (1985). "Primary acute pericardial disease: a prospective series of 231 consecutive patients". Am J Cardiol. 56 (10): 623–30. PMID 4050698.
- ↑ Mayosi BM, Burgess LJ, Doubell AF (2005). "Tuberculous pericarditis". Circulation. 112 (23): 3608–16. doi:10.1161/CIRCULATIONAHA.105.543066. PMID 16330703.
- ↑ Sagristà-Sauleda J, Angel J, Sánchez A, Permanyer-Miralda G, Soler-Soler J (2004). "Effusive-constrictive pericarditis". N Engl J Med. 350 (5): 469–75. doi:10.1056/NEJMoa035630. PMID 14749455.