대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Tuberculous lymphadenitis

Radiologic Findings

Figure 1. Chest PA shows a well demarcated, lobulated mass at the left hilar region.
Figure 2-3. Chest CT scans show a well-circumscribed, enhancing mass at left interlobar region.

Neck CT shows right cervical lymph nodes with margin thin rim enhancement (arrow). Lung scan CT shows focal nodules in RLL superior segment.

Pathology of excised right neck mass shows chronic granulomas with caseous necrosis and multinucleated giant cells. EBUS-TBNA of left hilar mass shows a few lymphocytes and epithelial cells with positive TB PCR.

Brief Review

CT findings of tuberculous lymphadenitis are variable, depending on the degree of caseation present in the node. Nodes may initially appear merely enlarged, often with attenuation similar to muscle. Eventually, central caseation develops and the nodes become centrally low density and eventually frankly cystic. Benign lesion including tuberculoma showed enhancement less than 15 HU in 107/185 subjects on dynamic CT scans. In terms of enhancement pattern, a left hilar mass in our case is likely to be a highly enhancing tumor about 160 HU on postenhanced CT with about 110 HU net enhancement so that we differentiate it as Castleman’s disease, cavernous hemangioma, etc as first impression. However, we can diagnose it as an active tuberculoma, as correlated with right cervial lymph nodes and lung CT findings. We’ve been experienced that tuberculomas are sometimes highly enhanced on CT and MRI.

Please refer to

Case 1, Case 77, Case 269, Case 713,

References

1) Swensen SJ, Viggiano RW, Midthun DE, Müller NL, et al. Lung nodule enhancement at CT: Multicenter study. Radiology. 2000; 214: 73-80.
2) Jeong YJ, Lee KS, Jeong SM, et al. Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT. Radiology 2005; 237: 675-683.
3) Ko SY, Chung MH, Lim YS, et al. Characteristics of Consolidation, Centrilobular Nodule and Bronchus as CT Findings for the Differentiation between Tuberculosis and Pneumonia. J Korean Soc Radiol 2013;68(6):463-472.

Keywords

mediastinum, lymph node, tuberculous,