A Very Nice Case...

[Ahmed Al-Kaisy]

A 45 years old woman from Haiti arrives at your clinic complaining of dyspnea and a dry cough, which she has had before 2 to 3 months. she has been unable to walk more than 200 feets before devloping severe SOB. she denies any fevers but has episodic night sweats. she tells u that she has been in the united state for about 6 weeks. physical examination reveals elevated JVP with prominent waveforms. notably, there is an increase in the venous distension with inspiration. her heart sounds are faint with an early third heart sound present. no murmur is heard. the right upper quadrant is tender and the liver pulsatile. ECG reveals sinus tachycardia but is otherwise normal. CXR reveals mild scarring of the right upper lobe of the lungs and a normal sized cardiac silhouette. the purified protein derivative (test for T.B.) is positive....

what is the probable diagnosis?

[ali al-kafaji]

hmmm , pulmanry hypertension lead to heart failure ?

ali

[Nader]

chest x-ray+symptoms=TB+complication Of pulmnry Hypt

Mx
we need to complet TB work-up do AFB,PCR and culture 6 months of anti tb first 2 months on INH+rifampin+PZA+ethambutol
then continue with 2 drugs for 4 months{INH+rifamamoin}

HF ?

[Hour_Glass]

1.elevated JVP with prominent waveforms
2.increase in the venous distension with inspiration
3.heart sounds are faint with an early third heart

triad of cardiac tamponade which developed from pericardial effusion and the causative agent is TB


regards

[Aljubouri83]

I'm thinking of " TB Pericarditis " ..

[Hour_Glass]

so what is the right answer?

[Samer Q N]

so Elevated JVP, Kusmaul's Sign, pulsatile liver, faint heart sounds and S3 without a murmur, and a normal silhouette on CXR, and a positive test for TB with CXR scarring of upper lobe.

I would say constrictive pericarditis, mostly due to TB
Cheers.