title: Asymptomatic primary tuberculous pleurisy with intense 18-fluorodeoxyglucose uptake mimicking malignant mesothelioma.
abstract: BACKGROUND
  The pathogenesis of primary tuberculous pleurisy is a delayed-type hypersensitivity immunogenic reaction to a few mycobacterial antigens entering the pleural space rather than direct tissue destruction by mycobacterial proliferation. Although it has been shown that pulmonary tuberculosis induces 18-fluorodeoxyglucose (FDG) uptake in active lesions, little is known about the application of FDG positron emission/computed tomography (FDG PET/CT) to the management of primary tuberculous pleurisy.
  
  
  METHODS
  We report a case of asymptomatic primary tuberculous pleurisy presenting with diffuse nodular pleural thickening without distinct pleural effusion and parenchymal lung lesions mimicking malignant mesothelioma. An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura and thoracoscopic biopsy of pleural tissue revealed caseous granulomatous inflammation. The patient received antituberculous therapy for 6 months, with clearly decreased positive signals on a repeated FDG PET/CT scan.
  
  
  CONCLUSIONS
  FDG PET/CT imaging may be useful for evaluating disease activity in tuberculous pleurisy patients with an unknown time of onset.
authors: Department of Clinical Investigation, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan. shinoharat@kochi2.hosp.go.jp
authors: Tsutomu
authors: T
authors: Shinohara
authors: Naoki
authors: N
authors: Shiota
authors: Motohiko
authors: M
authors: Kume
authors: Norihiko
authors: N
authors: Hamada
authors: Keishi
authors: K
authors: Naruse
authors: Fumitaka
authors: F
authors: Ogushi
mesh_terms: D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis*; D064847:Multimodal Imaging; D010994:Pleura / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D014396:Tuberculosis, Pleural / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D019788:Fluorodeoxyglucose F18