Some Aspects of the Pathogenesis of Cardiac Tuberculosis

I UBERCULOSIS of the heart is not a common condition. It is very often an autopsy finding, which clinically was of little or no importance, being but a part of a generalised tuberculous infection. Sixteen examples of cardiac tuberculosis were found among the records of 3,500 cases post-mortemed in the Institute of Pathology in the last ten years, an incidence of only 4.6 per 1,000. Of these sixteen cases there was direct evidence for regarding the condition as tuberculous in origin in ten only, but it is possible to bring forward strong circumstantial evidence that the cause of the pathological changes found in the other six cases was originated by infection with the tubercle bacillus. The following is a brief summary of the pathological features of these sixteen cases: CASE 1: Male, aged 23 years; generalised miliary tuberculosis with tubercles in the myocardium; endocardium and pericardium not affected; tuberculosis of the right epididymis with surgical removal two years previously; acute fibro-caseous tuberculosis of the right seminal vesicle; ante-mortem thrombi in the periprostatic, right internal and common iliac veins; infarction of the lung. CASE 2: Female, aged 50 years; generalised miliary tuberculosis with tubercles in the myocardium; endocardium and pericardium not affected; fibro-caseous tuberculosis of the upper lobe of the left lung; early tuberculous meningitis; also acute non-specific right sided mastoiditis, ethmoidal and sphenoidal sinusitis. CASE 3: Female, aged 15 years; generalised miliary tuberculosis with myocardial and subendocardial tubercles; pericardium not affected; fibro-caseous tuberculosis of the lower lobe of the right lung with tuberculous hilar adenitis; tuberculous meningitis; localised tuberculous peritonitis. CASE 4: Male, aged 22 years; generalised miliary tuberculosis with myocardial an(d subendocardial tubercles; pericardium healthy; right sided renal phthisis with tuberculosis of ureter, bladder, prostate and seminal vesicle; non-bacterial thrombotic endocarditis of the mitral valve superimposed on healed rheumatic endocarditis. CASE 5: Female, aged 45 years; solitary tuberculoma in the myocardium; endocardium andl pericardium healthy; no other tuberculous lesions found in any part of the bo(dy; diabetes and hyperglyc,emic coma. (Partial post-mortem examination only performed.) CASE 6: Female, aged 6 years; generalised miliary tuberculosis with subendocardial and myocardlial tubercles; endocardlial tuberculosis; large caseating areas in myocardium, extending through the endocardium and discharging caseous material into the heart cavity, and in direct communication with caseating areas