Chest ImagingTuberculoma
uncommon manifestation of
tuberculosis. This pattern may be the result of an extended primary infection where the virulence of the mycobacterial bacillus is countered by an equal resistance and immune response from the host. Thus
inflammation caused by the organism keeps development of the tuberculoma in check until the tuberculous bacilli overwhelm the defence and begin to grow again. The host defence mechanisms then regroup to limit growth. Thus the lesions are slow growing as reflected on chest films. Radiographs typically reveal a well-marginated round or sometimes oval opacity typically in the upper lobes (
Fig.1). Usually they are detected when 12 cm in diameter but can achieve 5 cm in size. "Satellite" lesions or multiple tuberculomas are not uncommon. As necrosis and chronic disease occurs in the centre of tuberculomas
calcification may be observed on the chest radiograph. Generally the
calcification is central but occasionally may involve most of the visible
lesion and at other times may be mottled or concentric. These lesions are generally stable for long periods of time only demonstrating slow growth over a period of several months or years. Cavitation is extremely rare with tuberculomas and suggests reactivation of disease. Generally tuberculomas are confused with
bronchogenic carcinoma but if suspected and diagnosed will resolve slowly with appropriate antituberculous therapy.
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A PA chest film demonstrates a fairly well marginated nodule, approximately 1 cm in diameter, in the right upper lobe. Tuberculomas are indistinguishable from lung cancer. There is no cavitation or calcification typically seen in tuberculomas. These are slow-growing lesions which, if treated appropriately, will gradually disappear over a period of weeks to months.
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Tuberculoma, Fig.1 | |