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TB as Global Constriction Cause — EECC MCQ

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EasyPericardial DiseaseTB as Global Constriction CauseEECC

A 45-year-old man from South Asia presents with constrictive pericarditis. He has a history of treated pulmonary tuberculosis 3 years ago. The pericardium is calcified on CT. What is the most common worldwide cause of constrictive pericarditis?

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Correct answer: C — Tuberculosis is the most common cause of constrictive pericarditis globally, particularly in endemic regions (South Asia, Sub-Saharan Africa); in developed countries, idiopathic/viral and post-cardiac surgery are the most common causes

The aetiology of constrictive pericarditis varies geographically: (1) Globally: TB is the leading cause (>50% in endemic regions — pericardial TB causes intense fibrinous inflammation → granulation tissue → pericardial fibrosis/calcification → constriction over months to years); (2) Developed countries: idiopathic/viral (~50%), post-cardiac surgery (~25%), post-radiation (~10%), connective tissue disease, and post-infectious (including TB in immigrant populations). The 2025 ESC Pericarditis Guidelines recommend TB workup in constrictive pericarditis, especially in: patients from endemic regions, immunocompromised individuals, and those with pericardial calcification. Tuberculous constrictive pericarditis requires: anti-TB treatment (standard 6-month regimen), corticosteroids may reduce progression to constriction (IMPI trial showed a non-significant trend), and pericardiectomy for established constriction refractory to medical therapy.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines; IMPI Trial