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无症状原发性结核性胸膜炎，18-氟脱氧葡萄糖摄取强烈，类似于恶性间皮瘤。

Asymptomatic primary tuberculous pleurisy with intense 18-fluorodeoxyglucose uptake mimicking malignant mesothelioma.

机构信息

Department of Clinical Investigation, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.

出版信息

BMC Infect Dis. 2013 Jan 14;13:12. doi: 10.1186/1471-2334-13-12.

DOI:10.1186/1471-2334-13-12
PMID:23317113
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3568019/
Abstract

BACKGROUND

The pathogenesis of primary tuberculous pleurisy is a delayed-type hypersensitivity immunogenic reaction to a few mycobacterial antigens entering the pleural space rather than direct tissue destruction by mycobacterial proliferation. Although it has been shown that pulmonary tuberculosis induces 18-fluorodeoxyglucose (FDG) uptake in active lesions, little is known about the application of FDG positron emission/computed tomography (FDG PET/CT) to the management of primary tuberculous pleurisy.

CASE PRESENTATION

We report a case of asymptomatic primary tuberculous pleurisy presenting with diffuse nodular pleural thickening without distinct pleural effusion and parenchymal lung lesions mimicking malignant mesothelioma. An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura and thoracoscopic biopsy of pleural tissue revealed caseous granulomatous inflammation. The patient received antituberculous therapy for 6 months, with clearly decreased positive signals on a repeated FDG PET/CT scan.

CONCLUSION

FDG PET/CT imaging may be useful for evaluating disease activity in tuberculous pleurisy patients with an unknown time of onset.

摘要

背景

原发性结核性胸膜炎的发病机制是对少数进入胸腔的分枝杆菌抗原的迟发型超敏免疫反应，而不是分枝杆菌增殖直接导致组织破坏。尽管已经表明肺结核可诱导活性病变摄取 18-氟脱氧葡萄糖（FDG），但对于 FDG 正电子发射/计算机断层扫描（FDG PET/CT）在原发性结核性胸膜炎管理中的应用知之甚少。

病例介绍

我们报告了一例无症状原发性结核性胸膜炎病例，表现为弥漫性结节性胸膜增厚，无明显胸腔积液和实质肺病变，类似于恶性间皮瘤。初始 FDG PET/CT 扫描显示右侧胸膜多处 FDG 摄取强烈，胸腔镜活检胸膜组织显示干酪样肉芽肿性炎症。患者接受了 6 个月的抗结核治疗，重复 FDG PET/CT 扫描显示阳性信号明显减少。

结论

FDG PET/CT 成像可能有助于评估发病时间不明的结核性胸膜炎患者的疾病活动度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/5a869f6783c0/1471-2334-13-12-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/13e9bcea8255/1471-2334-13-12-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/0ac85624dd5b/1471-2334-13-12-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/552aa01fc591/1471-2334-13-12-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/5a869f6783c0/1471-2334-13-12-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/13e9bcea8255/1471-2334-13-12-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/0ac85624dd5b/1471-2334-13-12-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/552aa01fc591/1471-2334-13-12-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ce/3568019/5a869f6783c0/1471-2334-13-12-4.jpg

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