Wang Xianlei, Zhang Ying, Zhang Huan, Zhang Zhihua, Xu Weile
Hebei Chest Hospital, Hebei, China.
Hebei Key Laboratory of Pulmonary Disease, Hebei, China.
IDCases. 2025 Jun 23;41:e02302. doi: 10.1016/j.idcr.2025.e02302. eCollection 2025.
Pulmonary nodules present a diagnostic dilemma, particularly in differentiating tuberculous nodules from malignant lesions. Misdiagnosis may lead to unnecessary surgery or delayed treatment. We report two cases where solitary pulmonary nodules were initially suspected as malignancies but were ultimately diagnosed as pulmonary tuberculosis. In Case #1, a diabetic patient with a left lower lobe nodule underwent resection, and postoperative pathology and molecular tests confirmed tuberculosis. In Case #2, a patient with prior pulmonary surgery developed a new right upper lobe nodule. Despite malignant imaging features, CT-guided biopsy and GeneXpert plus nanopore sequencing confirmed Mycobacterium tuberculosis, and anti-tuberculosis therapy led to lesion absorption without repeat surgery. CT imaging alone is insufficient to distinguish tuberculosis from malignancy. Integrating percutaneous biopsy with molecular diagnostics is essential for accurate diagnosis. In high-risk patients, postoperative anti-tuberculosis treatment should be considered. An individualized, multidisciplinary approach is critical to avoid overtreatment and improve outcomes.
肺结节带来了诊断难题，尤其是在区分结核结节与恶性病变方面。误诊可能导致不必要的手术或治疗延误。我们报告两例病例，最初孤立性肺结节被怀疑为恶性肿瘤，但最终被诊断为肺结核。病例1中，一名患有左下叶结节的糖尿病患者接受了切除术，术后病理和分子检测确诊为结核病。病例2中，一名曾接受过肺部手术的患者出现了新的右上叶结节。尽管具有恶性影像学特征，但CT引导下活检以及GeneXpert加上纳米孔测序确诊为结核分枝杆菌，抗结核治疗使病灶吸收，无需再次手术。仅靠CT成像不足以区分结核病与恶性肿瘤。将经皮活检与分子诊断相结合对于准确诊断至关重要。在高危患者中，应考虑术后抗结核治疗。个体化的多学科方法对于避免过度治疗和改善治疗效果至关重要。
