Pulmonary tuberculosis with left atrial tuberculoma
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.
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- 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.
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.
- Ngow HA, Khairina WM. Right atrial tuberculoma: a diagnosis too late. Cardiol J. 2012;18 (5): 560-3. Pubmed citation
- Cantinotti M, De Gaudio M, de Martino M et-al. Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report. BMC Infect. Dis. 2011;11 (1): 359. doi:10.1186/1471-2334-11-359 - Free text at pubmed - Pubmed citation
- Kapoor OP, Mascarenhas E, Rananaware MM et-al. Tuberculoma of the heart. Report of 9 cases. Am. Heart J. 1973;86 (3): 334-40. Pubmed citation