Di Renzo Chiara, Tabrizian Parissa, Kozuch David E, Fiel Maria Isabel, Schwartz Myron E
Liver Surgery at Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Hepatobiliary and Liver Transplant Unit, Padova University Hospital, Padova, Italy.
Am J Case Rep. 2020 Feb 5;21:e918901. doi: 10.12659/AJCR.918901.
BACKGROUND Miliary tuberculosis (MT) is the disseminated form of tuberculosis (TB) and it is a potentially fatal condition. Diagnosis is often delayed because symptoms are typically nonspecific or absent, and misdiagnosis in favor of other diseases is common. We report 2 cases of disseminated TB that were diagnosed during or after surgeries performed for other suspected diseases. CASE REPORT Imaging findings are not specific and cannot be relied upon to raise suspicion of MT. In the first case, besides other imaging techniques, we also performed a positron emission tomography-computed tomography (PET-CT) on the patient and the resulting, thick, fluorodeoxyglucose (FDG)-avid ring surrounding the liver first led to concern for peritoneal carcinomatosis. TB peritonitis was only identified on laparoscopy and biopsy. In the second case, CT and magnetic resonance imaging (MRI) findings of a solitary liver mass with an irregular enhancing rim and progressive enhancement led to a radiographic diagnosis of likely intrahepatic cholangiocarcinoma, The subsequent finding that the lesion was intensely FDG-avid without other foci of FDG uptake led to the decision to proceed with resection without a prior biopsy. CONCLUSIONS We have presented 2 patients with TB in whom clinical and imaging findings, and in particular, FDG-PET imaging, led to an erroneous clinical diagnosis of malignancy. An awareness that TB remains very much an active clinical problem in North America and that there are other reasons for FDG uptake on PET imaging besides cancer, is necessary in order to avoid unnecessary and potentially deleterious interventions in patients with TB.
背景 粟粒性肺结核（MT）是肺结核（TB）的播散形式，是一种潜在的致命疾病。由于症状通常不具特异性或无症状，诊断往往延迟，误诊为其他疾病的情况很常见。我们报告2例播散性肺结核病例，这些病例是在因其他疑似疾病进行手术期间或术后确诊的。病例报告 影像学表现不具特异性，不能依靠其来提高对粟粒性肺结核的怀疑。在第一例中，除其他影像学检查外，我们还对患者进行了正电子发射断层扫描-计算机断层扫描（PET-CT），结果显示肝脏周围有厚厚的、氟脱氧葡萄糖（FDG）摄取增高的环形影，首先让人担心是腹膜癌。仅通过腹腔镜检查和活检才确诊为结核性腹膜炎。在第二例中，计算机断层扫描（CT）和磁共振成像（MRI）显示肝脏有一个孤立肿块，边缘不规则强化且呈渐进性强化，影像学诊断可能为肝内胆管癌。随后发现该病变FDG摄取强烈且无其他FDG摄取灶，因此决定在未进行活检的情况下进行切除。结论 我们报告了2例肺结核患者，其临床和影像学表现，特别是FDG-PET成像，导致了对恶性肿瘤的错误临床诊断。必须认识到，在北美，肺结核仍然是一个非常活跃的临床问题，而且PET成像上FDG摄取增加除癌症外还有其他原因，以避免对肺结核患者进行不必要的、可能有害的干预。
