대한흉부영상의학회 Weekly Chest Cases

Case No : 182 Date 2001-04-21

Courtesy of Joon Beom Seo, M.D. / University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Age/Sex 32 / F
Chief ComplaintWeight loss 6 kg during 2 months

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary tuberculosis with cystic changes
Radiologic Findings: Chest radiograph shows bilateral patchy areas of consolidation. Poorly defined air space nodules are also seen at the peripheral areas of consolidation. Thin walled air cysts are suggested in left upper lung zone. Thin section CT scan obtained at the level of the aortic arch shows irregular cysts of various sizes in left upper lobe with areas of ground glass opacity. At lower level, Centrilobular nodules with branching opacities are seen in both lungs. Small air cysts are also seen in within consolidation.
Sputum studies revealed acid fast bacilli.
Brief Review: CT findings of pulmonary tuberculosis that appeared as multiple cystic lesions associated with air space consolidation were very rare. Ko et al, reported three cases of reversible cystic changes of pulmonary tuberculosis for the first time in 1997. They suggested three possible pathogenesis of this phenomenon: 1) drainage of necrotic lung parenchymal in the areas of consolidation, coupled with check-valve bronchiolar obstruction caused by edematous luminal narrowing with mural inflammation of the involved bronchiole; 2) areas of dilated bronchioles due to peribronchiolar fibrosis induced by granulomatous lesion in the bronchiolar walls; 3) interstitial air leakage with tubercle rupture and caseation necrosis.
With the antituberculous chemotherapy, the cystic lesions disappear and residual irregular lines remained on follow-up radiographs and CT scans.

Pulmonary tuberculosis with multiple cysts needs to be differentiated from othe cystic lung diseases, particularly P carinii pneumonia, Langerhans cell histiocytosis, lymphangioleiomyomatosis, sarcoidosis, and cystic lymphocytic interstitial pneumonia. Associated surrounding areas of centrilobular nodules and cavitating nodules may help distinguish tuberculosis from other cystic lung diseases.
References: Ko KS, Lee KS, Kim Y, Kim SJ, Kwon OJ, Kim JS. Reversible cystic disease associated with pulmonary tuberculosis: radiologic findings. Radiology 1997;204:165-169
Keywords: Lung, Infection, Bacterial infection, tuberculosis,

No. of Applicants : 24

▶ Correct Answer : 19/24, 79.2%

- 嫄닿뎅
- 怨
- 怨源
- 怨
- 愿二媛李쏀
- 源吏
- 遺二쇱
- 遺理湲곕났
-
-
- 源
-
- 源
- 異⑸
- Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami
- Samsung Medical Center Tae Sung Kim
- Seoul City Boramae Hospital Jae-Woo Song
- Seoul National University Hospital Tae Jung Kim
- Stedelijk OLV-Ziekenhuis Mechelen, Belgium Ivan Pilate

▶ Semi-Correct Answer : 3/24, 12.5%

- 留臾멸린
- CHU Nancy Brabois France Denis Regent
- Ospedale di Fabriano, Italy Giancarlo Passarini

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 182 Date 2001-04-21

Discussion

No. of Applicants : 24