{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:35:06Z","timestamp":1760060106620,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Tuberculosis (TB) is an ancient and re-emerging granulomatous infectious disease that continues to challenge public health. Early diagnosis and prompt effective treatment are crucial for preventing disease progression and reducing both morbidity and mortality. These steps play a vital role in infection control and in lowering death rates at both individual and population levels. Although diagnostic methods have improved sufficiently in recent decades, TB can still present with ambiguous laboratory and imaging features. This ambiguity can lead to diagnostic pitfalls and potentially disastrous outcomes due to delayed diagnosis. In this article, we present a case of TB that was difficult to diagnose. The disease had invaded the mediastinum, right atrium, right coronary artery, and inferior vena cava (IVC), resulting in Budd\u2013Chiari syndrome. This rare presentation created clinical, laboratory, and radiological confusion, resulting in a diagnostic dilemma that ultimately led to open cardiac surgery. The patient initially presented with progressive shortness of breath on exertion and fatigue, which suggested possible heart disease. This suspicion was reinforced by computed tomography (CT) imaging, which showed infiltrative mass lesions predominantly in the right side of the heart, invading the right coronary artery and IVC, with imaging features mimicking angiosarcoma. Although laboratory findings revealed an exudative effusion with lymphocyte predominance and elevated adenosine deaminase (ADA), the Gram stain was negative for bacteria, and an acid-fast bacilli (AFB) smear was also negative. These findings contributed to diagnostic uncertainty and delayed the confirmation of TB. Open surgery with excisional biopsy and histopathological analysis ultimately confirmed TB. We conclude that TB should not be ruled out solely based on negative Mycobacterium bacteria in pericardial effusion or AFB smear. TB can mimic aggressive tumors such as angiosarcoma or lymphoma with invasion of the surrounding tissues and blood vessels. Awareness of the clinical presentation, imaging findings, and potential diagnostic pitfalls of TB is essential, especially in endemic regions.<\/jats:p>","DOI":"10.3390\/pathogens14080772","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T07:45:11Z","timestamp":1754466311000},"page":"772","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multisystemic Tuberculosis Masquerading as Aggressive Cardiac Tumor Causing Budd\u2013Chiari Syndrome Disseminated to the Brain Resulting in Death of a Six-Year-Old Boy"],"prefix":"10.3390","volume":"14","author":[{"given":"Eman S.","family":"Al-Akhali","sequence":"first","affiliation":[{"name":"Department of Radiology, Al Anwar Medical Hospital, Hail 55424, Saudi Arabia"},{"name":"Department of Radiology, Advanced AlRazi Diagnostic Center, Sana\u2019a 999101, Yemen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-6989","authenticated-orcid":false,"given":"Sultan Abdulwadoud","family":"Alshoabi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Halah Fuad","family":"Muslem","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dr. Suliman Al Habib Hospital Altakhasosi, Riyadh 12344, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8196-3233","authenticated-orcid":false,"given":"Fahad H.","family":"Alhazmi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8936-7479","authenticated-orcid":false,"given":"Amirah F.","family":"Alsaedi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2982-2935","authenticated-orcid":false,"given":"Kamal D.","family":"Alsultan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amel F.","family":"Alzain","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6854-4624","authenticated-orcid":false,"given":"Awatif M.","family":"Omer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0627-194X","authenticated-orcid":false,"given":"Maisa","family":"Elzaki","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-5294","authenticated-orcid":false,"given":"Abdullgabbar M.","family":"Hamid","sequence":"additional","affiliation":[{"name":"Radiology Department, Rush University Medical Group, Chicago, IL 60612, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hatiya, M., Merid, Y., Mola, A., Belayneh, F., and Ali, M.M. (2025). Prevalence of drug-resistant Mycobacterium tuberculosis and its associated factors among tuberculosis patients attending Dilla university referral hospital, Ethiopia. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-11191-z"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Girma, A., Kassawmar, F., Kassa, Y., and Asrat, Y. (2025). Nanoparticles as an Alternative Strategy for the Rapid Detection of Mycobacterium tuberculosis Complex (MTBC): A Systematic Literature Review of In Vitro Studies. IET Nanobiotechnol., 2025.","DOI":"10.1049\/nbt2\/4639233"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Salvador, V.G., Undurraga, E.A., Escobar, N., Garc\u00eda, C., Vergara, N., and Balcells, M.E. (2025). Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: A time-dependent survival analysis in Chile. Lancet Reg. Health Am., 46.","DOI":"10.1016\/j.lana.2025.101119"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"202","DOI":"10.5005\/jp-journals-10005-2763","article-title":"A Rare Case of Tubercular Osteomyelitis of Mandible in a 5-year-old Child","volume":"17","author":"Khan","year":"2024","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/S1473-3099(20)30400-X","article-title":"The uncertainty of tuberculosis diagnosis","volume":"20","author":"Datta","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Alshoabi, S.A., Almas, K.M., Aldofri, S.A., Hamid, A.M., Alhazmi, F.H., Alsharif, W.M., Abdulaal, O.M., Qurashi, A.A., Aloufi, K.M., and Alsultan, K.D. (2022). The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12020306"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.12669\/pjms.346.16350","article-title":"Tuberculous Meningitis, Vasculitis, and Pericarditis presented by deep coma","volume":"34","author":"Alshoabi","year":"2018","journal-title":"Pak. J. Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Guo, Y., Liu, Q., and Wu, H. (2023). Primary cardiac tumor: A case report of right atrial angiosarcoma and review of the literature. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1164153"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e04582","DOI":"10.1002\/ccr3.4582","article-title":"Primary cardiac angiosarcoma directly invading the right lung: An autopsy report","volume":"9","author":"Kiwaki","year":"2021","journal-title":"Clin. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Yu, J.F., Cui, H., Ji, G.M., Li, S.Q., Huang, Y., Wang, R.N., and Xiao, W.F. (2019). Clinical and imaging manifestations of primary cardiac angiosarcoma. BMC Med. Imaging, 19.","DOI":"10.1186\/s12880-019-0318-4"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4068\/cmj.2014.50.1.27","article-title":"Diffuse infiltrative primary cardiac lymphoma with delayed extracardiac involvement","volume":"50","author":"Jeoung","year":"2014","journal-title":"Chonnam Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"263","DOI":"10.3892\/ol.2025.15009","article-title":"Diffuse myocardial infiltration in secondary cardiac lymphoma: A case report","volume":"29","author":"Huang","year":"2025","journal-title":"Oncol. Lett."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"123","DOI":"10.11613\/BM.2014.014","article-title":"Pleural, peritoneal and pericardial effusions\u2014A biochemical approach","volume":"24","author":"Kopcinovic","year":"2014","journal-title":"Biochem. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Dybowska, M., B\u0142asi\u0144ska, K., G\u0105tarek, J., Klatt, M., Augustynowicz-Kope\u0107, E., Tomkowski, W., and Szturmowicz, M. (2022). Tuberculous Pericarditis-Own Experiences and Recent Recommendations. Diagnostics, 12.","DOI":"10.3390\/diagnostics12030619"},{"key":"ref_15","first-page":"8","article-title":"Pericardial effusion in oncological patients: Current knowledge and principles of management","volume":"10","author":"Mori","year":"2024","journal-title":"Cardiooncology"},{"key":"ref_16","first-page":"304","article-title":"Incremental Diagnostic Value of Computed Tomography Attenuation in Differentiating Malignant Pericardial Effusion: A Retrospective Observational Study","volume":"53","author":"Tekin","year":"2025","journal-title":"Turk. Kardiyol. Dern. Ars."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"327","DOI":"10.4103\/ijmy.ijmy_89_21","article-title":"Tuberculosis presenting as metastatic lung cancer","volume":"10","author":"Saleemi","year":"2021","journal-title":"Int. J. Mycobacteriol."},{"key":"ref_18","first-page":"e78201","article-title":"A Rare Case of a Solitary Central Nervous System Tuberculoma Mimicking an Intracranial Tumor","volume":"17","author":"Gakidi","year":"2025","journal-title":"Cureus"},{"key":"ref_19","first-page":"1048","article-title":"Tuberculous Granuloma of the Brain","volume":"3","author":"Gameraddin","year":"2016","journal-title":"Austin. J. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5908","DOI":"10.1016\/j.radcr.2024.08.083","article-title":"Giant cerebral tuberculoma mimicking tumor in a pediatric patient: A case report","volume":"19","author":"Nurhayati","year":"2024","journal-title":"Radiol. Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.radcr.2023.10.015","article-title":"Intramedullary tuberculoma of the thoracic spine presented as paraparesis: A rare case report","volume":"19","author":"Abdu","year":"2023","journal-title":"Radiol. Case Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"117","DOI":"10.5152\/tao.2018.3191","article-title":"Primary Sinonasal Tuberculosis: A Diagnostic Challenge","volume":"56","author":"Dey","year":"2018","journal-title":"Turk. Arch. Otorhinolaryngol."},{"key":"ref_23","first-page":"1296","article-title":"Paraspinal tuberculosis mimicking malignancy","volume":"34","author":"Alherabi","year":"2013","journal-title":"Saudi Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s12072-021-10257-9","article-title":"Hepatic tuberculosis masquerading as malignancy","volume":"16","author":"Kale","year":"2022","journal-title":"Hepatol. Int."},{"key":"ref_25","first-page":"89","article-title":"Tuberculose isol\u00e9e du pancr\u00e9as et des ganglions p\u00e9ripancr\u00e9atiques: Challenge diagnostique [Isolated tuberculosis of pancreas and peripancreatic lymph nodes: Diagnostic challenge]","volume":"87","author":"Benkabbou","year":"2009","journal-title":"Tunis Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.patol.2019.02.008","article-title":"Esophageal tuberculosis in an HIV-positive patient mimicking a spindle cell tumor","volume":"52","year":"2019","journal-title":"Rev. Espa\u00f1ola Patol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e262626","DOI":"10.1136\/bcr-2024-262626","article-title":"Colonic tuberculosis mimicking malignancy: A multidisciplinary medical and surgical approach","volume":"18","author":"Chen","year":"2025","journal-title":"BMJ Case Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/ijmy.ijmy_19_25","article-title":"When Peritoneal Tuberculosis Mimics Carcinomatosis: A Diagnostic Enigma","volume":"14","author":"Resendes","year":"2025","journal-title":"Int. J. Mycobacteriol."},{"key":"ref_29","first-page":"e76231","article-title":"Peritoneal Tuberculosis Mimicking Ovarian Malignancy: A Case Report","volume":"16","author":"Hamedat","year":"2024","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"110031","DOI":"10.1016\/j.ijscr.2024.110031","article-title":"Ovarian tuberculosis mimicking ovarian malignancy in an unvaccinated patient: A case report","volume":"122","author":"Harouachi","year":"2024","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1007\/s13224-024-02069-2","article-title":"Unmasking the Masquerade: Navigating the Diagnostic Enigma of Abdominal TB Mimicking Endometriosis","volume":"75","author":"Ifthikar","year":"2025","journal-title":"J. Obstet. Gynaecol. India"},{"key":"ref_32","first-page":"67","article-title":"Isolated Prostate Tuberculosis Mimicking Prostate Cancer","volume":"34","author":"Legesse","year":"2024","journal-title":"Ethiop. J. Health Sci."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/8\/772\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:23:24Z","timestamp":1760034204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/8\/772"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,5]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["pathogens14080772"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14080772","relation":{},"ISSN":["2076-0817"],"issn-type":[{"type":"electronic","value":"2076-0817"}],"subject":[],"published":{"date-parts":[[2025,8,5]]}}}