대한흉부영상의학회 Weekly Chest Cases

Case No : 1206 Date 2020-12-07

Courtesy of Bo Mi Gil, Myung Hee Chung / Bucheon St. Mary
Age/Sex 21 / F
Chief Complaintpalpable right neck mass, 1month ago

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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
References: 1) Swensen SJ, Viggiano RW, Midthun DE, M
Keywords: mediastinum, lymph node, tuberculous,

No. of Applicants : 59

▶ Correct Answer : 4/59, 6.8%

- , Korea (South) JIN YOUNG LEE
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
- GEMS, Srikakulam, Andhra Pradesh , India RAMU C

▶ Correct Answer as Differential Diagnosis : 9/59, 15.3%

- The University of Tokyo Hospital , Japan MOTO NAKAYA
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- , Korea (South) EUNJIN LEE
- Chungbuk National University Hospital , Korea (South) MINJI SONG
- Ajou University Hospital , Korea (South) HYERIN KIM
- Other , Korea (South) KYU-CHONG LEE
- Fortis hospital , Mohali , India SHALEEN RANA
- Nishida Hospital , Japan SHOJI OKUDA
- Chungbuk National University Hospital , Korea (South) HYE SOO CHO

▶ Semi-Correct Answer : 1/59, 1.7%

- Holy Family Hopsital , India RAJESH GOTHI

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1206 Date 2020-12-07

Discussion

No. of Applicants : 59