대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary Tuberculosis and Non-specific Interstitial Pneumonia

Radiologic Findings

Chest radiograph shows smooth-contoured mass shadow in right mid lung zone with ill-defined patchy increased opacities in both lower lung zones. Enhanced CT scans show irregular-shaped mass in superior segment of right lower lobe which appears to be composed of multiple aggregated nodules with necrosis and enhancing portions. There are also enlarged lymph nodes in the hilum. On high resolution CT scans, ground-glass opacities are distributed in periphery of both lower lobes with interlobular and intralobular interstitial thickening, traction bronchiectasis, and some foci of consolidation.

Brief Review

Mycobacterium tuberculosis was confirmed from culture of bronchial washing fluid in this patient. Antituberculous therapy was started and follow-up examination showed decreased size of lung mass but persistent interstitial lung disease. Open lung biopsy revealed nonspecific interstitial pneumonia of mixed disease of cellular and fibrotic patterns.
A number of abnormalities are known to be associated with an increased risk for the development of tuberculosis. They include silicosis, diabetes mellitus, chronic renal failure, alveolar proteinosis, the postgastrectomy state, iron overload, as well as immunocompomised state. There is some evidence for an increased risk of tuberculosis in systemic lupus erythematosus although it is not clear whether this is related to therapy or the disease itself. Despite extensive search for the literature, no report has been found which describes an association of tuberculosis with idiopathic interstitial pneumonia.

References

1. Fraser, Muller, Colman, Pare. Diagnosis of diseases of the chest, 4th edition.

Keywords

Lung, Infection, Bacterial infection, Tuberculosis,