Pulmonary tuberculosis with left atrial tuberculoma

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Chest pain, cough and haemoptysis. Echocardiography showed a left atrial mass lesion. The patient gave a past medical history of pulmonary tuberculosis for which he had received medical treatment.

Patient Data

Age: 62 years
Gender: Male
  • Left lung upper lobe anterior and apico-posterior segments as well as superior and inferior lingular consolidations with multilocular marginally enhancing lesions are seen with small calcifications seen at the apicoposterior and anterior segment of the left upper lobe.
  • Hypodense marginally-enhancing lesions are seen infiltrating and filling the left superior and inferior pulmonary veins with a large left atrial marginally enhancing hypodense lesion filling almost its entire cavity and measuring 8.5 X 6.2 cm in its maximal axial dimensions. The lesion is encroaching upon and attenuating the left ventricular outflow tract.
  • Bilateral lower lung lobes posterior and lateral segments as well as right lung middle and upper lobes scattered subsegmental consolidation with military nodulations and tree-in-bud appearance.
  • Right lung upper lobe apical segment fibrocalcific scarring with reticulo-nodular infiltration and subpleural bullae consistent with old tuberculous infection.
  • Enlarged left hilar as well as mediastinal lymphadenopathy.     
  • Minimal right pleural effusion.
  • No gross cardiomegaly.
  • The upper sections of the abdomen show no significant abnormality.

Case Discussion

The above described findings are those of reactivated or post-primary pulmonary tuberculosis with left lung upper and lingular lobar consolidations with caseating granulomas (tuberculomas), bilateral pulmonary miliary nodulations as well as left pulmonary veins and left atrial marginally enhancing lesions; suggestive of intracardiac tuberculosis with small right pleural effusion, enlarged left hilar and mediastinal lymphadenopathy. The differential diagnosis of the left atrial mass lesion is atrial thrombus and less likely myxoma.

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Case information

rID: 42316
Case created: 15th Jan 2016
Last edited: 26th Aug 2016
System: Chest
Inclusion in quiz mode: Included

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