대한흉부영상의학회 Korean Society of Thoracic Radiology

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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesCases by Disease Category

Case No : 1175 Date 2020-04-28

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  • Courtesy of Hyun-ju Lim, Kun Young Lim, Soo Hyun Lee, Hyae Young Kim / National Cancer Center
  • Age/Sex 60 / M
  • Chief ComplaintCough for 1 month / Ex-smoker (25 pack years)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pulmonary tuberculosis
Radiologic Findings
Fig 1. Chest PA shows nodular opacity at right hilum.
Fig 2. CT scans show low attenuating peribronchial nodular lesions surrounding right upper lobar bronchus.
Fig 3. The lesion shows mild FDG uptake.

On Bronchoscopy, there was no endobronchial lesion. The patient underwent right upper lobectomy.
Surgical specimen revealed necrotic intrapulmonary or peribronchial LN-like nodules containing necrotizing granulomatous inflammation. TB PCR was positive.

Brief Review
Mediastinal and hilar lymphadenopathy is the most common radiologic manifestation of primary tuberculosis. Lymphadenopathy in tuberculosis typically demonstrates a low attenuation center with peripheral rim enhancement on contrast material enhanced CT images, due to central caseous necrosis with peripheral granulomatous inflammatory tissue. The differential diagnoses of necrotic lymphadenopathy include nontuberculous mycobacterial infection, lymphoma, and metastatic carcinoma. Lymphadenopathy is seen in 83%-96% of pediatric cases of primary tuberculosis and 10%-43% of adult cases and typically involves the right paratracheal and hilar lymph nodes.
Please refer to
Case 77, Case 184, Case 371, Case 567, Case 574, Case 925, Case 993,
KSTR Imaging Conference 2002 Spring  Case 7,
References
Nachiappan et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics 2017;37:52-72
Keywords
lung, lung nodule, tuberculosis,

No. of Applicants : 78

▶ Correct Answer : 3/78,  3.8%
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Nishida Hospital , Japan SHOJI OKUDA
▶ Correct Answer as Differential Diagnosis : 14/78,  17.9%
  • - , Korea (South) SUNGEUN YUN
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan SHIN-ICHI CHO
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , India SUSHANT JOSHI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - , Japan SOTA MASUOKA
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