Constrictive pericarditis is a complication of tuberculous pericarditis that 
necessitates surgical intervention. In this study, we sought to identify 
echocardiographic features that could predict the development of constrictive 
pericarditis from acute or subacute pericarditis. From January 1988 through May 
1998, all patients with a discharge diagnosis of tuberculous pericarditis were 
enrolled in the study, and their clinical features, laboratory findings, 
sonographic images, treatments, and outcomes were analyzed. Tuberculous 
pericarditis was demonstrated on the basis of positive Mycobacterium 
tuberculosis cultures from pericardial fluid or tissue in 11 patients; 
pericardial biopsy specimens demonstrating caseating granulomas in seven; and 
bacteriologic or histologic evidence of active extra-pericardial tuberculosis in 
conjunction with major pericardial effusion in four. Seventeen patients had 
effusive tuberculous pericarditis and five had constrictive tuberculous 
pericarditis as the initial diagnosis. The echocardiographic findings of 
effusive pericarditis were classified as shaggy-type effusion (n = 8) and 
non-shaggy-type effusion (9). Shaggy effusion was defined as the presence of 
multiple fibrin strands or a mass-like exudate coating the pericardium and 
bridging the pericardial effusion. Non-shaggy effusion was characterized by an 
anechoic pericardial space with or without a thickened pericardium, but no 
shaggy exudative coating. The mean duration between the onset of symptoms and 
diagnosis was longer in patients with shaggy-type effusion (39.6 +/- 8.7 vs 21.0 
+/- 13.9 days, p < 0.05). Prednisolone (20-30 mg/d) was used in addition to 
antituberculous chemotherapy in 11 of the 17 patients with effusive 
pericarditis. Two of 11 patients (18%) who received steroid therapy, and five of 
the six patients (83%) who did not, developed constrictive pericarditis in the 
following year. Therefore, we concluded that adjuvant therapy with steroids 
significantly decreased the risk of constrictive pericarditis in patients with 
non-shaggy, but not shaggy, effusion.