tuberculous pericarditis is found in approximately 1% of all autopsied patients with tuberculosis and in 1 - 2% of cases of pulmonary tuberculosis;1 ) however , pericardial tuberculoma is a rare complication . during evaluation of pericardial masses , echocardiography is useful for assessment of location and hemodynamic effects . computed tomography ( ct ) and magnetic resonance imaging ( mri ) can provide more accurate information regarding the location , extent , and character of the mass and its invasion into adjacent organs . therefore , we present here a case demonstrating typical features of pericardial tuberculoma by imaging . a 62-year - old woman was admitted for evaluation of dyspnea and chest discomfort in september of 2009 . the patient had a past medical history of a mastectomy of the right breast due to abscess 35 years earlier . she had been diagnosed with effusive tuberculous pericarditis in december 2008 , at which time she underwent pericardiostomy and drainage . since then , she had taken antituberculous therapy with isoniazid , rifampin , ethambutol , and pyrazinamide . in january 2009 , her regimen was changed to isoniazid , ethambutol , and levofloxacin due to development of drug - induced hepatotoxicity , after which she had no discomfort and her laboratory findings normalized . however , from may 2009 , her dyspnea and chest discomfort showed a gradual increase . upon physical examination , her blood pressure was 130/85 mm hg , heart rate was 63 bpm , and respiratory rate was 18 bpm . in addition , her heart and lung sounds were normal , as were the results of her laboratory examinations . a chest radiography revealed a new rounded bulging of the superior cardiac border and an adjacent lung nodule ( fig . subsequent evaluation of her mass lesion included enhanced chest ct , and two - dimensional echocardiography . ct images confirmed a pericardial mass measuring approximately 4 - 5 cm protruding into the lung parenchyma . the mass was located on the superior - anterior aspect of the left ventricle and had an irregular margin with non - enhanced central necrosis . no evidence of constrictive physiology or mass effect was noted . because the patient had maintained her antituberculous medication , and lung cancer is more prevalent than primary pericardial tumor or abscess , lung cancer with pericardial invasion was considered based on the ct and echocardiographic findings . therefore , in july 2009 , a video - assisted thoracotomy biopsy was conducted for confirmation of lung cancer . however , histopathology revealed chronic granulomatous inflammation with caseating necrosis , which ruled out lung cancer . the patient next underwent cardiac mri and positron emission tomography - computed tomography ( pet - ct ) for evaluation of myocardial invasion and metastasis . cardiac mri ( 1.5 t , siemens , germany ) revealed a mass with hyper - enhanced rim and mixed signal intensity central core of the mass on delayed enhancement images ( fig . 3 ) . on pet - ct , high glucose uptake of the left ventricle , pericardial and lung mass , and subcarinal lymph node although acid - fast bacilli were not demonstrated , she was diagnosed with pericardial tuberculoma based on the histologic findings . after 2 months , her symptoms were relieved and the size of the pericardial tuberculoma was somewhat reduced . no lung nodules were observed on a follow up chest radiography in march 2010 ( fig . in the case presented here , the patient had a history of tuberculous pericardial effusion and drainage . therefore , her pericardial mass could have been considered a pericardial tuberculoma spreading into the lung parenchyma . because the patient had regularly taken medication over a period of six months and imaging showed that the soft tissue portion was relatively large , the pericardial mass was misinterpreted as invasive lung cancer . during evaluation of pericardial masses however , ct and mri can provide more accurate information regarding the location , extent , and character of the mass and its invasion into adjacent organs . using ct and mri , gulati et al.2 ) a smooth , thin enhancing rim and a hypodense core with heterogeneity or septa were features of the tuberculous abscess on ct . the report also showed that the presence of a hypointense core on t2-weighted mri , as seen in our case , could be suggestive of tubercular etiology . upon gadolinium - enhanced mri , peripheral rim enhancement and central hypoenhancement of the mass were reported for tuberculoma.3 ) these mri findings were correlated with central necrosis and prominent vascularity within the inner fibrous and outer cellular layers seen on microscopic examination.4 ) in this case , pet - ct showed a false - positive result , so that exclusion of lung cancer by pet - ct was not possible . although pet - ct is helpful for the differentiation of benign and malignant tumors , inflammatory diseases ( tuberculous pleuritis and parapneumonic effusion ) are included within the false positives.5 ) pericardial tuberculoma may require pathologic confirmation for exact diagnosis ; however , more precise information regarding imaging tests , including ct , mri , and pet - ct , will be helpful in making decisions regarding methods for use in tissue confirmation , surgical approach , and treatment . our case showed typical features of pericardial tuberculoma by imaging , and pericardial tuberculoma should be considered as a differential diagnosis for a pericardial mass , despite adequate antituberculous therapy . our case showed typical features of pericardial tuberculoma by imaging , and pericardial tuberculoma should be considered as a differential diagnosis for a pericardial mass , despite adequate antituberculous therapy .
tuberculosis generally affects the respiratory tract . in developing nations 
 , the pericardium is the most common location of extrapulmonary tuberculosis ; however , tuberculous pericarditis rarely appears as a localized mass or tuberculoma . 
 we present here a case of a 62-year - old woman with pericardial tuberculoma . 
 she had a history of effusive tuberculous pericarditis and drainage . because she had taken regular medication over a period of six months , the pericardial mass with an adjacent lung nodule newly detected on the chest radiogram was initially suspected of being invasive lung cancer . 
 prior to pathologic confirmation , precise information from imaging tests , including computed tomography , magnetic resonance imaging , and positron emission tomography - computed tomography are helpful when making decisions regarding which methods should be used for surgical approach and treatment . through imaging , 
 our case showed typical features of pericardial tuberculoma and a favorable clinical course after two months with a change in antituberculous therapy .