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Weekly Chest CasesArchive of Old Cases

Case No : 567 Date 2008-09-08

  • Courtesy of Hyo Lim Kim, MD, Myeong Im Ahn, MD, Seog Hee Park, MD. / Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
  • Age/Sex 52 / M
  • Chief ComplaintDry cough for 2 month
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pulmonary Tuberculosis, showing “galaxy sign (clusters of small nodules)”
Radiologic Findings
Chest PA shows multiple clustered nodular and streaky opacities in both upper and mid lung zones. CT scans show multiple irregular shaped nodules surrounded by many tiny satellite nodules in both lungs. There is no definite evidence of mediastinal LAP. AFB was demonstrated on bronchoaveolar lavage fluid and bronchial washing culture revealed tuberculous mycobacterium.
Brief Review
“Galaxy sign” firstly refers to large pulmonary nodules composed of coalescent small nodules, and surrounded by many tiny satellite nodules in pulmonary sarcoidosis, simulating the appearance of a galaxy. Pathologically, the sarcoid galaxy of the large nodule represents innumerable coalescent granulomatous lesions.

Large nodules arising from the coalescence of small nodules may also be seen in active tuberculosis, and these features appeared indistinguishable from the sarcoid galaxy sign. Heo et al. suggested that 1) a single cluster of small nodules, 2) clusters of small nodules in the superior segment of the lover lobe, or 3) clusters of small nodules not associated with lymphadenopathy or 4) associated with tree-in-bud lesions would favor the diagnosis of active tuberculosis rather than pulmonary sardoidosis.
References
1. Nakatsu M, Hatabu H, Morikawa K, et al. Large coalescent parenchymal nodules in pulmonary sarcoidosis: ”sarcoid galaxy” sign AJR 2002;178:1389-1393
2. Heo JN, Choi YW, Jeon SC, et al. Pulmonary tuberculosis: another disease showing clusters of small nodules AJR 2005;184:639-642
Keywords
Lung, Interstitium, Infection, Bacterial infection, Tuberculosis,

No. of Applicants : 81

▶ Correct Answer : 11/81,  13.6%
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - hospital Sao Paulo , Brazil israel missrie
  • - chest hospital , Egypt assaad assaad
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - kmc , India vijay bharodiya
  • - McGill university , Canada Makki Almuntashri
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Mackay Memorial Hospital , Taiwan Shen ShengYeh
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Correct Answer as Differential Diagnosis : 24/81,  29.6%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - SMG-SNU Boramae Hospital , Korea (South) Daehee Han
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - Hanmaeum Hospital , Korea (South) Kwon Kim
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Saga University , Japan Ryoko Egashira
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - UCLA , United States Fereidoun Abtin
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - radiology department ANNECY , France gilles GENIN
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
▶ Semi-Correct Answer : 17/81,  21.0%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Kashan University of Medical Sciences, kashan, Iran , Iran Ebrahim Razi
  • - Osaka University , Japan Osamu Honda
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - BOLLINENI HOSPITAL NELLORE , India jignesh dubal
  • - jiangsu province hospital , China yuan doctor
  • - Cheongshim international medical center , Korea (South) Hae Jum Yang
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - BATRA HOSPITAL NEW DELH , India MONIKA AGARWAL
  • - CHU Grenoble , France Fabrice Bing
  • - wonju christial hospital , Korea (South) daekeon Lim
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - EKH-Berlin , Germany Michael Weber
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
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