Tuberculosis can secondarily affect the heart, mainly the pericardium and less frequently the endocardium and coronary vessels. Tuberculous myocarditis usually is a post-mortem diagnosis, and affects the right atrium and left ventricle presenting as miliary granulomas with or without caseating necrosis, or as diffuse cellular infiltration. We report the case of a 65-year-old man, affected by tuberculous lymphadenitis, with a history of hyperkinetic atrial and ventricular arrhythmias. Magnetic resonance, transthoracic and transesophageal echocardiography showed a peculiar cardiac involvement, characterized by right ventricular and left atrial infiltration. As the patient refused myocardial biopsy, the diagnosis of tuberculous myocarditis was stated ex-adjuvantibus, after specific multidrug chemotherapy with complete remission of all echocardiographic abnormalities. Echocardiography represents a useful diagnostic tool in patients presenting with clinical and electrocardiographic features, that even not specific could be suggestive of tuberculous myocarditis, whose incidence could be greater than reported in the literature.