A 29-year-old immunocompetent woman presented with increasing dyspnoea for 1 month, fever of unknown origin and cough. The electrocardiogram was unremarkable. Laboratory tests showed mild inflammatory syndrome and anaemia. Transthoracic echocardiography demonstrated a hyperechogenic invasive intra pericardial mass invading the two atria with characteristics suggesting a malignant tumour (Panel A). This was confirmed by transoesophageal echocardiography (Panel B, *) which better demonstrated the extension of the mass towards the right atrial wall and invasion of periaortic space and left atrial appendage (Panel C, *). Notably, pulmonary parenchyma was normal on both chest radiography (Panel D) and computed tomography (not shown). Cardiac MRI showed isointense and homogeneous signal on T1- and T2-weighted imaging (Panel E–F) and steady-state free precession cine imaging (Panel G) and heterogeneous hyper-enhancement with central necrosis after Gd enhanced T1 weighted image (Panel H,*). Surgical pericardial biopsy by open thoracotomy demonstrated necrosing granuloma (Panel I) suggestive of tuberculosis confirmed by Polymerase Chain Reaction analysis. Treatment with quadruple anti-tuberculosis drugs therapy was initiated and the clinical evolution was good.
Conflict of interest: None declared.
