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Weekly Chest CasesArchive of Old Cases

Case No : 993 Date 2016-11-07

  • Courtesy of Sung Ho Hwang, Yu-Whan Oh, Soo-Youn Ham / Korea University Anam Hospital
  • Age/Sex 47 / F
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Tuberculosis
Radiologic Findings
Chest radiography (Fig. 1) showed multiple hazy areas and linear opacities indicating the fibrosis or atelectasis in both lung fields. On the chest CT images (Fig. 2), the right mediastinum shows a 2 cm irregular soft tissue density nodule which protrudes into the right main bronchus. In addition, the left lung shows multifocal bronchial wall thickening and irregular consolidations in the left lower lobe.
Brief Review
"Tuberculosis of Right Bronchus and Mediastinum"
Tuberculosis of the airways typically involves the distal trachea and proximal main bronchi. In most cases, active infection and associated mediastinal inflammation result in diffuse increased density of mediastinal fat or enlarged mediastinal or pericardial lymph nodes on CT images. Untreated tuberculosis may lead to ulceration with resulting fistula between mediastinal lymph nodes and adjacent airways. The differential diagnosis includes bronchogenic carcinoma. Longer circumferential airway involvement and the absence of intraluminal mass favors tuberculosis. In the present case, however, main bronchial intraluminal lesion mimicked bronchogenic carcinoma.

References
1. Moon WK, Im JG, Yeon KM, Han MC. Tuberculosis of the central airways: CT findings of active and fibrotic disease. AJR Am J Roentgenol. 1997 Sep;169(3):649-53
Keywords
airway, mediastinum, Infection,

No. of Applicants : 85

▶ Correct Answer : 8/85,  9.4%
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - , Korea (South)
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - Maternity & child hospital , Saudi Arabia Sania ALBlushi
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
▶ Correct Answer as Differential Diagnosis : 22/85,  25.9%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kyungpook national university hospital, Korea , Korea (South) Sung Jun Moon
  • - Chungbuk national university hospital , Korea (South) Miran Yeon
  • - GHICL , France manuel toledano
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Private sector , Greece Vasilios Tzilas
  • - chungbuk university hospital , Korea (South) 瑜˜
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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