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Sandeep Gupta



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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.CR-22 - Pulmonary Tuberculosis – A Chameleon; Mimicking Lung Cancer on Imaging (ID 12292)

      12:00 - 13:30  |  Author(s): Sandeep Gupta

      • Abstract
      • Slides

      Background

      Tuberculosis (TB) often mimics other diseases including malignancy, and has been rightly called a benign imposter. Most common radiographic appearances seen in TB are cavitary, fibroproductive, exudative, acinary, micro and macronodular and miliary types.The typical presentation of pulmonary tuberculosis is easily recognisable but the disease, a well-known masquerader, can be a source of diagnostic confusion radiologically when the presentation is atypical., especially in the regions in which the tuberculosis is endemic. Tuberculosis may be radiographically revealed as mass formation in the cases clinically and radiographically examined, difficulties may be encountered in the differential diagnosis due to the similar constitutional symptoms such as fatigue, breathlessness , and anorexia both in tuberculosis and carcinoma, and the radiologic appearance is also confusing.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 65 year old female patient was referred to our department with a 3 months history of breathlessness, chest tightness, intermittent non-productive cough and unintended weight loss of 5 kg in the past 2 months. She had no reported fever or any prior medical history. A presumptive diagnosis of lung cancer was made from elsewhere based on her radiological appearance on computed tomography (CT) scan of chest which showed a large peripherally located enhancing solid mass lesion in the posterobasal segment of right lower lobe and another solid necrotic lesion in right middle lobe abutting the pericardium along with multiple nodular opacities. CT guided fine needle aspiration cytology was done from the lesion and it showed acute on chronic inflammation. The next diagnostic step was bronchoscopy with negative results regarding malignancy. The bronchial wash samples were also sent to microbiology with negative results for bacteria, fungi, even negative on direct microscopy but Cartridge based nucleic acid amplification test (CBNAAT) (Polymerase Chain Reaction based) for Mycobacterium tuberculosis provided the diagnosis by showing growth of the Mycobacterium tuberculosis.

      4c3880bb027f159e801041b1021e88e8 Result

      The patient was diagnosed as pulmonary tuberculosis and started on standard anti-TB-therapy and she responded symptomatically as well as with clearing of the lesion, radiologically.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In conclusion, tuberculosis emerging as a large nodular or mass-like radiographic appearance is uncommon and this can be easily confused with the tumoral formations. Differentiation from lung cancer based on imaging findings alone may be challenging and often ambiguous, thereby highlighting the importance of use of interventions like bronchoscopy in suspecting cases.

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