Ann Thorac Surg 2006;81:2338
© 2006 The Society of Thoracic Surgeons
Correspondence
Video-Assisted Thoracoscopy and Tuberculous Pericarditis
Felipe Francisco Tuon, MD
Department of Infectious and Parasitic Diseases, School Of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, São Paulo, SP 05403-000 Brazil
(Email: ffbt{at}pop.com.br).
To the Editor:
We read with interest the article by Georghiou and colleagues [1] and agree with their approach to pericardial effusions. In areas where the incidence of tuberculosis is high, pericardial effusion is always a challenge. Often patients are treated empirically with anti-tuberculous drugs, which may cause toxicity and adverse events. This is a common problem in underdeveloped countries that have a high incidence of AIDS. Tuberculous pericarditis (TP) is the main differential diagnosis in pericardial effusions caused by AIDS. Although microbiology and cultures of the pericardial fluid are negative in most cases of TP, laboratory and histologic findings are very important. Adenosine deaminase measurements are an important marker of tuberculosis in both pericardial and pleural effusions [2]. This test must be always used when pericardiac and pleural diseases are investigated. Histologic findings and adenosine deaminase measurements improve the diagnostic accuracy of TP to 90% of sensitivity, sensibility, and specificity.
Video-assisted thoracoscopy is a very important diagnostic method [3]. It is a safe and minimally invasive technique that allows biopsies and fluid analysis from pericardial and pleural effusions [4]. There is no prospective study of video-assisted thoracoscopy for the diagnosis of TP. In a prospective series of TP, only 50% of patients meet definitive diagnostic criteria of tuberculosis. The other 50% have only a presumptive diagnosis of tuberculosis after a clinical response to empirical treatment. These data can be changed with a more aggressive approach. A correct diagnosis of pericardial tuberculosis decreases mortality and the most serious complication, which is constrictive pericarditis. Video-assisted thoracoscopy can be an important approach to TP because it has advantages in comparison with other surgical methods.
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References
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- Georghiou GP, Stamler A, Sharoni E, et al. Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions Ann Thorac Surg 2005;80(2):607-610.[Abstract/Free Full Text]
- Reuter H, Burgess LJ, Carstens ME, Doubell AF. Adenosine deaminase activity—more than a diagnostic tool in tuberculous pericarditis Cardiovasc J S Afr 2005;16(3):143-147.[Medline]
- Yim AP. The role of video-assisted thoracoscopic surgery in the management of pulmonary tuberculosis Chest 1996;110(3):829-832.[Abstract/Free Full Text]
- Cherian G. Diagnosis of tuberculous aetiology in pericardial effusions Postgrad Med J 2004;80(943):262-266.[Abstract/Free Full Text]
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