Tuberculous Pericarditis- On examination, the patient’s neck veins were distended, and heart sounds were muffled. An electrocardiogram showed sinus tachycardia and low-voltage complexes in the limb and precordial leads. Transthoracic echocardiography revealed a large pericardial effusion with evidence of tamponade (Panel A [arrow] and Video 1). The effusion contained extensive intrapericardial fibrin strands with a wormlike appearance (Panel B and Video 2). Pericardiocentesis was performed, and hemodynamic stability was achieved after direct aspiration of 1400 ml of purulent fluid; a pericardial drain was placed. The adenosine deaminase level in the pericardial fluid was 100 U per liter (reference range, 0 to 9), and examination of the pericardial fluid revealed acid-fast bacilli. A diagnosis of tuberculous pericarditis was made. Testing for human immunodeficiency virus was positive... #NEJM #clinical #radiology #tuberculous #pericarditis #transthoracic #echocardiography #echo
