Datta Ananda, Sivasankar Raghavendrun, Mallik Sonali
Pulmonary Medicine, All India Institute of Medical Sciences Deoghar, Deoghar, Jharkhand, India
Pulmonary Medicine, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India.
BMJ Case Rep. 2025 Jan 8;18(1):e264033. doi: 10.1136/bcr-2024-264033.
Tuberculosis (TB) is a great mimicker due to its various unusual and atypical presentations. Mass-like lesions in thoracic radiology may raise the suspicion of lung malignancy. A man in his early 50s complained of cough, low-grade fever and dyspnoea. Chest radiograph was suggestive of a right hilar mass. Contrast-enhanced CT of the thorax revealed right perihilar consolidation and mediastinal lymphadenopathy. The lesion was encasing the major vessels, causing luminal narrowing. Flexible bronchoscopy showed multiple mucosal nodules in the right lobar bronchi. Histopathology of the endobronchial biopsy showed chronic inflammatory cell infiltrate, while endobronchial ultrasound-guided fine needle aspiration cytology from mediastinal lymph nodes showed numerous caseating epithelioid cell granulomas. Cartridge-based nucleic acid amplification test of lymph node aspirate detected that was not resistant to rifampicin. So, the final diagnosis was pulmonary TB. The man improved with 6 months of standard antituberculosis therapy. This case represents an uncommon radiological presentation of pulmonary TB.
结核病（TB）因其各种不寻常和非典型表现而极具迷惑性。胸部放射学检查中出现的团块状病变可能会引发对肺部恶性肿瘤的怀疑。一名50岁出头的男性主诉咳嗽、低热和呼吸困难。胸部X光片提示右肺门肿块。胸部增强CT显示右肺门周围实变及纵隔淋巴结肿大。病变包绕主要血管，导致管腔狭窄。纤维支气管镜检查显示右叶支气管有多个黏膜结节。支气管活检的组织病理学显示慢性炎性细胞浸润，而纵隔淋巴结的支气管内超声引导下细针穿刺细胞学检查显示大量干酪样上皮样细胞肉芽肿。淋巴结穿刺液的基于 cartridge 的核酸扩增检测未发现对利福平耐药。因此，最终诊断为肺结核。该男子接受6个月的标准抗结核治疗后病情好转。此病例代表了肺结核一种不常见的放射学表现。
