Pleural tuberculosis presented as multiple pleural masses: An atypical presentation

Our plain-English summary of Pleural tuberculosis presented as multiple pleural masses: An atypical presentation, by A. Patel, S. Choudhury (Lung India, 2013).

The study

• Authors: A. Patel, S. Choudhury
• Journal: Lung India
• Published: 2013;30(1):54-6
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Tuberculous involvement of the pleura usually presents as pleural effusion, empyema or pleural thickening. Pleural tuberculosis presenting with multiple masses without parenchymal involvement or lymphadenopathy has been reported rarely in the English literature. We report a case of a 68-year-old male with unilateral pleural tuberculosis presenting as multiple different sized nodular masses evident on computed tomography (CT) of the chest with a large hemorrhagic pleural effusion, which initially raised a possibility of mesothelioma. Pleuroscopy also revealed multiple pleural masses. Pathological examination of the biopsy specimen showed multiple epitheloid cell granulomas confirming the diagnosis.

In plain English

This case report, from a pulmonary medicine department in Gujarat, India, described one 68-year-old man with three months of worsening breathlessness and dry cough. He chewed tobacco and had no history of asbestos exposure. About 1.5 litres of bloody fluid was drained from around his right lung. The fluid was mostly lymphocytes and showed no cancer cells. X-ray and CT scans then showed multiple masses of different sizes on both layers of the pleura, the lining of the lung and chest wall. CT showed no signs of infiltrates in the lung tissue, airway lesions or enlarged lymph nodes in the central chest. These findings initially raised the possibility of mesothelioma, and the provisional diagnosis was a pleural tumor. A biopsy taken through a scope inside the chest showed epitheloid cell granulomas indicating tuberculosis. The authors concluded that tuberculosis can mimic cancer and should be considered when pleural masses appear without visible lung disease, even with a large bloody effusion. They added that confirming the diagnosis is mandatory. As a single case, it shows what happened to one patient, not how often this occurs.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 68-year-old man treated at the authors' Department of Pulmonary Medicine in Vadodara, Gujarat, India. He had progressive breathlessness on exertion and dry cough for three months, and pleuritic chest pain, low-grade fever and weight loss for one month. The date of the case is not stated.
• Exposure: No asbestos exposure. The patient was a tobacco chewer. The condition studied was pleural tuberculosis, not an asbestos exposure.
• Main results:
  • About 1.5 L of hemorrhagic (bloody) fluid was drained from the right chest. It was a lymphocytic exudate (lymphocytes 92%, adenosine deaminase 9 IU/L), with cytology negative for malignant cells and negative gram stain and AFB smear.
  • CT of the chest showed multiple masses of different sizes on both the parietal and visceral pleura. It showed no signs of endobronchial lesions, mediastinal lymph node enlargement or lung parenchymal infiltrates.
  • Based on clinical, radiological and pleuroscopic findings, the provisional diagnosis was a pleural neoplasm (primary or secondary). The abstract states this initially raised a possibility of mesothelioma.
  • A biopsy from a parietal pleural mass, taken at pleuroscopy, showed epitheloid cell granulomas indicative of tuberculosis.
• The authors' conclusion: The authors concluded that tuberculosis can mimic malignancy. They said it should be considered in the differential diagnosis of pleural masses without radiographically visible lung disease, even with a large hemorrhagic effusion. They also stated that confirming the diagnosis by sputum smear, culture or histology is mandatory.

Topics

Medical terms in this study, explained in our Lexicon: Pleura, Pleural Effusion, Empyema, Pleural Thickening, Lymphadenopathy, Mesothelioma, Biopsy, Granuloma.

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