Pericardial tuberculosis is usually caused by extension from a contiguous focus of infection, such as mediastinal or hilar nodes, the lung, spine, or sternum. Dissemination to the pericardium can occur with military tuberculosis. The onset may be abrupt or insidious. Patients may present with dyspnea, orthopnea, dull retrosternal pain, a pericardial friction rub, or symptoms and signs of cardiac tamponade. Fever, weight loss and night sweats usually occur before cardiopulmonary complaints. A few patients present with findings of chronic constrictive pericarditis. A pleural effusion can be found in as many as 39% of cases with pericardial tuberculosis, and radiographic evidence of concurrent pulmonary tuberculosis in 32%-72% of cases.