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Weekly Chest CasesArchive of Old Cases

Case No : 936 Date 2015-10-05

  • Courtesy of Jou Sung Shick, Kim Young Tong / Soonchunhyang university cheonan hospital
  • Age/Sex 36 / M
  • Chief ComplaintChest PA abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Tuberculoma
Radiologic Findings
3. Chest radiograph shows ovoid single nodule in RML with fissural thickening. That nodule enlarged compared with chest radiograph taken in 4 years. On chest CT, 3 cm size mass containing dense calcification is located in RML abutting thickened major and minor fissures. Enhancement is not seen within that mass and there was no satellite nodule. Pathologic finding of PTNB specimen was chronic caseous granulomatous inflammation and mycobacterium tuberculosis PCR of tissue was positive.
Brief Review
5. A pulmonary tuberculoma is one of the most common benign nodules and represents 5-24% of resected SPNs appearing a well-marginated smooth nodule or mass. The satellite lesions are in as many as 80% of cases. Diffuse or nodular calcification is found in 20-30% of the lesions. The presence of benign-looking calcification within the nodule, adjacent tree-in-bud lesions, or satellite nodules may help in differentiating tuberculomas from malignant nodules. The proposed mechanism is repeated extension of infection, subsequent a core of caseous necrosis surrounded by a mantle of epithelioid cells and multiple concentric layers of connective tissue. Most lesions are stable, but enlargement or the development of a new lesion should be considered either reactivation of tuberculosis or a malignancy.
References
1.Goo JM, Im JG, Do KH, et al. Pulmonary tuberculomaevaluated by means of FDG PET: findings in 10 cases. Radiology 2000;216(1):117
2.Lee HS. Response of pulmonary tuberculomas to anti-tuberculous treatment. Eur Respir J 2004;23:452
3.Thoracic Imaing 2001: pulmonary tuberculosis volume 6, 2001 KSTR
Keywords
Lung, Infection, Bacterial infection,

No. of Applicants : 102

▶ Correct Answer : 7/102,  6.9%
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - stanley medical college , India yazhini v
  • - the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Santosh hospital,Bengaluru , India Pravin Mahadevappa
▶ Correct Answer as Differential Diagnosis : 22/102,  21.6%
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - GHICL , France manuel toledano
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Ajou University Hospital , Korea (South) Young Keun Sur
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - IRSA La Rochelle , France Denis Chabassiere
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - NASA SCANS , India RAKESH BHATIA
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
▶ Semi-Correct Answer : 11/102,  10.8%
  • - university of montreal , Canada Andrei Gorgos I
  • - privato , Italy genchi enzo
  • - MUHC , Canada Hani AlSalam
  • - University of British Columbia , Canada Amr Ajlan
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - 寃쎈 , Korea (South) SUNG MOON
  • - Ajou University Hospital , Korea (South) Boram Yi
  • - Pusan national university hospital , Korea (South) hie bum suh
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
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