812 Fig. 1 Echocardiography showing a large pericardial effusion with exudative debris and fibrin strands. RV right ventricle, LV left ventricle, LA left atrium, PE pericardial effusion of tuberculosis [6]. Children in particular are at high risk of the development of extra-pulmonary disease [5]. Clinical manifestations of tuberculous pericarditis are nonspecific and cardiopulmonary complaints usually develop later. Accumulation of pericardial fluid may compromise venous return, leading to cardiac failure. Echocardiography plays a major role in confirming the presence of a pericardial effusion. In addition, several echocardiographic abnormalities including pericardial thickening, exudative coating and strands crossing the pericardial space are suggestive of tuberculous pericarditis. Thickened pericardium and fibrin strands are highly specific (94% and 88% respectively), and exudative coating has a high sensitivity (100%) in tuberculous pericarditis [4]. The diagnosis is confirmed with detection of Mycobac- terium tuberculosis in either pericardial fluid or pericardial tissue. Pericardial fluid aspiration, however, has low diagnostic yield, both for PCR and culture, whereas pericardial biopsy provides the best chance of definitive diagnosis [2, 6]. A positive tuberculin skin test may increase the suspicion of tuberculous pericarditis, but a negative skin test does not exclude the diagnosis. A Eur J Pediatr (2008) 167:811–812 tuberculin skin test was not performed in this case because the girl had been immunized with BCG. There was no history of any family members being diagnosed with TBC. The spread of tuberculosis to the pericardium, resulting in an effusion, occurs most often from the mediastinal lymph glands. However, pericarditis may also represent reactivation of disease in the absence of an apparent primary focus of infection [3]. Current recommendations for treatment of tuberculous pericarditis include an initial four-drug regimen for a period of 8 weeks with a subsequent continuation phase of treat- ment for 4 months when the isolate is drug-susceptible [1]. Controversy exists with respect to the use of corticosteroids for tuberculous pericarditis. The American Thoracic So- ciety’s consensus statement on tuberculosis recommends adjunctive therapy with corticosteroids (1 mg/kg of pred- nisolone with tapering over 11 weeks) for tuberculous pericarditis [1]. References 1. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka V, Menzies RI, O’Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA (2003) American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 167:603–662 2. Cegielski JP, Devlin BH, Morris AJ, Kitinya JN, Pulipaka UP, Lema LE, Lwakatare J, Reller LB (1997) Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericardi- tis. J Clin Microbiol 35:3254–3257 3. Cherian G, Habashy AG, Uthaman B, Hanna RM (2003) Tuberculous pericardial effusion-mediastinal lymph glands: the cause and clue to the etiology. Indian Heart J 55:228–233 4. Liu PY, Li YH, Tsai WC, Tsai LM, Chao TH, Yung YJ, Chen JH (2001) Usefulness of echocardiographic intrapericardial abnormal- ities in the diagnosis of tuberculous pericardial effusion. Am J Cardiol 87:1133–1135 5. Maltezou HC, Spyridis P, Kafetzis DA (2000) Extra-pulmonary tuberculosis in children. Arch Dis Child 83:342–346 6. Trautner BW, Darouiche RO (2001) Tuberculous pericarditis: optimal diagnosis and management. Clin Infect Dis 33:954–961