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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 94

Tuberculosis or not tuberculosis: Attente cogitanti


Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Submission19-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Ritesh Agarwal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2156_19

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How to cite this article:
Muthu V, Agarwal R. Tuberculosis or not tuberculosis: Attente cogitanti. Indian J Med Res 2020;152, Suppl S1:94

How to cite this URL:
Muthu V, Agarwal R. Tuberculosis or not tuberculosis: Attente cogitanti. Indian J Med Res [serial online] 2020 [cited 2021 Jul 29];152, Suppl S1:94. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/94/316752

Patient's consent obtained to publish clinical information and images.


A 40 yr old male presented to the Chest Clinic, department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India, in December 2015, with fever, cough, and anorexia for the past 20 days. Chest radiograph revealed mediastinal widening. Positron-emission tomography-computed tomography (PET-CT) scan confirmed the presence of enlarged mediastinal lymph nodes, which were intensely fluorodeoxyglucose (FDG) avid [Figure 1]. Interestingly, on the maximum intensity projection image, the tuberculin skin test site showed intense FDG uptake [Figure 1], thereby suggesting the aetiology to be tuberculosis. Endobronchial ultrasound-guided transbronchial aspiration from the mediastinal nodes showed necrotic granuloma. Mycobacterium tuberculosis was detected using Xpert MTB/RIF from the lymph node aspirate. Treatment with standard anti-tubercular therapy resulted in a clinical and radiological resolution. At six months' follow up, a CT chest was normal.
Figure 1: Maximum intensity projection image of the positron-emission tomography scan showing the presence of fluorodeoxyglucose-avid mediastinal lymph nodes (white arrow) and tuberculin skin test site (black arrowhead).

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In clinical medicine, there are several instances where a closer scrutiny can suggest a diagnosis, such as PET-CT in this instance.


    Figures

  [Figure 1]



 

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