Tuberculous Constrictive Pericarditis Presenting with Isolated Pleural Effusion: Diagnostic Value of Transthoracic Echocardiography

Abstract

Aims: To highlight the diagnostic role of transthoracic echocardiography (TTE) in tuberculous constrictive pericarditis (CP) presenting atypically as isolated pleural effusion, and to emphasize the importance of early multimodal imaging in TB-endemic regions. Presentation of Case: A 36-year-old man with no comorbidities presented with progressive dyspnea and bilateral pleural effusion. Initial workup (CT, pleural biopsy) was inconclusive. TTE revealed classic CP features: pericardial thickening, septal bounce, and hepatic vein expiratory reversal. Cardiac MRI confirmed the diagnosis. Following clinical improvement with anti-tuberculosis therapy, the patient was referred for elective pericardiectomy. Discussion: CP remains a diagnostic challenge due to nonspecific symptoms. In TB-endemic areas, tuberculosis is a leading cause. TTE’s Mayo Clinic criteria (septal shift, medial e′ ≥ 9 cm/s, hepatic vein reversal) achieved 97% specificity, obviating invasive tests. MRI further differentiated CP from restrictive cardiomyopathy. Conclusion: CP should be considered in patients with unexplained pleural effusion in TB-endemic regions. TTE is a critical first-line tool, and early intervention improves outcomes.