[Be cautious with a prognosis!].
A 37-years old patient of south Indian origin presented with pain in his right scapular region radiating to the right arm, numbness and muscular weakness of the fourth and fifth finger. Computed tomography (CT) revealed a mass at the right pleural dome with arrosion of the first rib (Pancoast presentation), an osteolytic process in the fourth rib and in the right hip. All three lesions had a high FDG uptake in the PET/CT suggestive for lung cancer metastases in this smoker. Surprisingly, the CT-guided fine needle biopsy revealed no malignancy, but granulomatous inflammation and epitheloid cells. Microscopy for acid-fast bacilli (AFB) was negative, but the culture was positive for AFB. The HIV-negative patient received a regular antituberculous chemotherapy. His condition as well as the radiological findings improved gradually. In the majority of cases, space occupying masses in the upper sulcus are caused by non-small cell lung cancers. Extrapulmonal tuberculosis infection presenting as a Pancoast syndrome is a curiosity. However, with respect to the patients ethnical background this diagnosis should have been considered earlier.
Klinik für Pneumologie, UniversitätsSpital Zürich, Zürich. daniel.franzen@usz.ch
Daniel
D
Franzen
Tsogyal
T
Latshang
Thomas
T
Frauenfelder
Erich W
EW
Russi
D000328:Adult; D044963:Biopsy, Fine-Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000473:pathology; D002574:Cervical Vertebrae / Q000473:pathology; D003937:Diagnosis, Differential; D018450:Disease Progression; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D011379:Prognosis; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000473:pathology; D013904:Thoracic Vertebrae / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000473:pathology