A diagnostic trap: Malignant pericardial effusion mimicking tuberculous pericarditis

Our plain-English summary of A diagnostic trap: Malignant pericardial effusion mimicking tuberculous pericarditis, by M. Rashmika, U. Jadhav, B. Ghewade, et al (IDCases, 2026).

The study

• Authors: M. Rashmika, U. Jadhav, B. Ghewade, A. Soni, B. Mathur
• Journal: IDCases
• Published: 2026;44:e02597
• Read it: PubMed · Publisher · Free full text

Abstract

A middle-aged male with a history of treated pulmonary tuberculosis and industrial asbestos exposure complained of increasing dyspnea and chest pain for 15 days. Upon examination, he was tachycardic (100/min), tachypneic (24/min), hypotensive (100/60 mmHg), with raised jugular venous pressure and muffled heart sounds. A respiratory examination revealed decreased breath sounds in the right lung fields. Chest radiography (Fig. 1) demonstrated gross cardiomegaly with a globular cardiac silhouette suggestive of massive pericardial effusion, along with calcified pleural plaques on the right and post-tuberculous fibrotic changes with volume loss in the right upper lobe. Transthoracic echocardiography revealed a significant circumferential pericardial effusion (>20 mm) with symptoms of cardiac tamponade, including right atrial and ventricular collapse and a plethoric inferior vena cava (Adler et al., 2025 [1]). Emergency pericardiocentesis was performed. The aspirated fluid was haemorrhagic with an adenosine deaminase (ADA) level of 27.5 U/L, which was not supportive of tuberculous etiology (Porcel et al., 2010 [2]). Cytological examination revealed malignant cells. Contrast-enhanced computed tomography (Fig. 2) of the chest demonstrated a spiculated lesion in the left upper lobe. CT-guided biopsy confirmed non-small cell lung carcinoma. Immunocytochemistry was positive for thyroid transcription factor-1, consistent with lung adenocarcinoma. This case highlights a diagnostic challenge in tuberculosis-endemic regions, where prior TB history can lead to anchoring bias. Both tuberculous and malignant pericardial effusions may present similarly (Burazor et al., 2013 [3], Ben-Horin et al., 2006 [4]). Haemorrhagic fluid with low ADA should prompt evaluation for malignancy. Early cytological analysis is critical, as it has significant diagnostic and prognostic value in malignant pericardial effusion (Gornik et al., 2005 [5]).

© 2026 The Authors.

In plain English

This short case report described one middle-aged man with a history of treated pulmonary tuberculosis and industrial asbestos exposure. The article gave no details of the exposure, such as fiber type or duration. He had worsening breathlessness and chest pain for 15 days. A chest X-ray suggested a large fluid collection around the heart. It also showed calcified pleural plaques on the right and scarring from past tuberculosis in the right upper lung. Heart ultrasound showed the fluid was compressing the heart (cardiac tamponade), and the fluid was drained as an emergency. It was bloody and contained malignant cells. Its adenosine deaminase level of 27.5 U/L was, the authors said, not supportive of tuberculosis. A CT scan showed a spiculated lesion in the left upper lobe. A biopsy confirmed non-small cell lung carcinoma, consistent with lung adenocarcinoma. The article did not discuss whether asbestos played any role. The authors concluded that a past history of tuberculosis can mislead doctors (anchoring bias) in regions where tuberculosis is common. They also concluded that bloody fluid with low adenosine deaminase should prompt evaluation for cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One middle-aged man with a history of treated pulmonary tuberculosis and industrial asbestos exposure. No exact age, place of treatment or date is given; the authors are from Datta Meghe institutes in India.
• Exposure: Industrial asbestos exposure, with no fiber type, job, duration or dose given. The patient also had prior treated pulmonary tuberculosis.
• Main results:
  • Chest X-ray showed calcified pleural plaques on the right and post-tuberculous scarring with volume loss in the right upper lobe.
  • Echocardiography showed a circumferential pericardial effusion of more than 20 mm with signs of cardiac tamponade.
  • The drained pericardial fluid was haemorrhagic, with an adenosine deaminase level of 27.5 U/L, which the authors said did not support a tuberculous cause.
  • Cytology of the fluid showed malignant cells.
  • CT showed a spiculated lesion in the left upper lobe.
  • Biopsy confirmed non-small cell lung carcinoma, and immunocytochemistry was consistent with lung adenocarcinoma.
• The authors' conclusion: The authors concluded that in tuberculosis-endemic regions a prior TB history can lead to anchoring bias, because tuberculous and malignant pericardial effusions may look alike. They concluded that haemorrhagic fluid with low adenosine deaminase should prompt evaluation for malignancy.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Effusion, Asbestos Exposure, Dyspnea, Pleural Plaques, Cardiac Tamponade, Pericardiocentesis, Etiology, Biopsy.

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