J Korean Soc Radiol.  2012 Sep;67(3):161-168. 10.3348/jksr.2012.67.3.161.

Pulmonary Tuberculosis Mimicking Lung Cancer on Radiological Findings: Evaluation of Chest CT Findings in Pathologically Proven 76 Patients

• Kim HO
• Seon HJ
• Lee D
• Shin SS
• Kim YH
• Kang HK

• KMID: 2097966
• DOI: http://doi.org/10.3348/jksr.2012.67.3.161

Abstract

PURPOSE
To evaluate chest CT features of pulmonary tuberculosis mimicking lung malignancy.
MATERIALS AND METHODS
We retrospectively reviewed chest CT findings for 76 consecutive patients (21-84 years, average: 63 years; M : F = 30 : 46) who underwent an invasive diagnostic procedure under the suspicion of lung cancer and were pathologically diagnosed as pulmonary tuberculosis by bronchoscopic biopsy (n = 49), transthoracic needle biopsy (n = 17), and surgical resection (n = 10). We categorized the chest CT patterns of those lesions as follows: bronchial narrowing or obstruction without a central mass-like lesion (pattern 1), central mass-like lesion with distal atelectasis or obstructive pneumonia (pattern 2), peripheral nodule or mass including mass-like consolidation (pattern 3), and cavitary lesion (pattern 4). CT findings were reviewed with respect to the patterns and the locations of the lesions, parenchymal abnormalities adjacent to the lesions, the size, the border and pattern of enhancement for the peripheral nodule or mass and the thickness of the cavitary wall in the cavitary lesion. We also evaluated the abnormalities regarding the lymph node and pleura.
RESULTS
Pattern 1 was the most common finding (n = 34), followed by pattern 3 (n = 23), pattern 2 (n = 11) and finally, pattern 4 (n = 8). The most frequently involving site in pattern 1 and 2 was the right middle lobe (n = 14/45). However, in pattern 3 and 4, the superior segment of right lower lobe (n = 5/31) was most frequently involved. III-defined small nodules and/or larger confluent nodules were found in the adjacent lung and at the other segment of the lung in 31 patients (40.8%). Enlarged lymph nodes were most commonly detected in the right paratracheal area (n = 9/18). Pleural effusion was demonstrated in 10 patients.
CONCLUSION
On the CT, pulmonary tuberculosis mimicking lung cancer most commonly presented with bronchial narrowing or obstruction without a central mass-like lesion, which resulted in distal atelectasis and obstructive pneumonitis.

MeSH Terms

Biopsy
Biopsy, Needle
Humans
Lung
Lung Neoplasms
Lymph Nodes
Pleural Effusion
Pneumonia
Pulmonary Atelectasis
Retrospective Studies
Thorax
Tuberculosis, Pulmonary

Figure

• 

  Fig. 1 Pattern 1: Abrupt cutoff of bronchus without central mass-like lesion. A. Chest radiograph in a 65-year-old woman shows ill-defined mass-like opacity in the right perihilar area. B. CT scan at the carinal level shows abrupt cutoff (arrow) of anterior segmental bronchus of the right upper lobe with distal peribronchial consolidation. C. Coronal reformatting CT scan shows enlarged lymph node in the right hilar area (arrow) without evidence of bronchial compression. D. Follow-up chest radiograph after ten months of antituberculous chemotherapy shows marked contraction of the lesion.

• 

  Fig. 2 Pattern 2: Bronchial obstruction with central mass-like lesion. A. Lateral chest radiograph in a 68-year-old man shows atelectasis and consolidation in lower lung zones. B-D. CT scans show concentric wall thickening of the right bronchus intermedius (arrow in B) and central mass-like lesion (arrow in C), which is obliterating the right lower lobar bronchial lumen, which has continuity to surrounding calcified lymph nodes (arrow in D) at a slightly upper level of C.

• 

  Fig. 3 Pattern 3 (I): Heterogeneously enhancing peripheral mass. A. Chest radiograph in a 35-year-old man shows approximately a 6 cm well defined mass-like opacity obscuring the diaphragmatic border in the right lower lung field and patchy and nodular increased opacity in the right mid lung field. B. CT scan at the level of the inferior vena cava shows a heterogeneously enhancing mass containing multiple areas of necrotic low attenuation areas with peripheral rim enhancement and extension to the adjacent pleural space in the posterior aspect of the right basal lung. A small amount of pleural effusion is also noted (arrowheads). C, D. CT scans at the level of the left atrium show another subpleural nodule (about 2 cm) with adjacent pleural thickening (arrowheads in C) and multiple small satellite nodules in the surrounding lung parenchyma (D, lung window setting).

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  Fig. 4 Pattern 3 (II): Poorly enhancing peripheral nodule with necrotic lymphadenopathy. A. Chest radiograph in a 37-year-old woman shows about a 1.5 cm nodule in the left upper lung field with multiple small nodules along the bronchovascular bundle in the surrounding lung field. B. CT scan at the level of the aortic arch shows a poorly enhancing (mean HU: about 8) nodule in the apicoposterior segment of the left upper lobe. C. CT scan with lung window setting shows small centrilobular nodules and linear branching opacities in the surrounding lung parenchyma. D. CT scan at a slightly lower level shows an enlarged lymph node (arrow) containing low attenuation necrotic portion with peripheral rim-like enhancement in the aortopulmonary window area. Note.-HU = Hounsfield unit

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  Fig. 5 Pattern 4: Cavitary lesion with homogeneous low-attenuated wall. A. Chest radiograph in a 60-year-old man shows about a 3.5 cm well-defined mass-like opacity in the right infrahilar area. B, C. CT scans at the level of the left atrium show a cavitary mass (maximal thickness: about 12 mm) with a necrotic low attenuation wall (B, mean HU: about 4), speculated margin, and multiple small satellite nodules (C, lung window setting) in the superior segment of the right lower lobe. Note.-HU = Hounsfield unit

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