Presentation
Recent history of significant weight loss from 18 kg to 11 kg over a four month duration.
Patient Data
Multiple pathologically enlarged bilateral hilar and mediastinal discrete lymph nodes are seen at pre-vascular, retrocaval, pre-carinal and azygo-esophageal locations. They are seen heterogeneous enhancement with areas of low attenuation and mainly peripheral calcifications within. Multiple bilateral enlarged axillary and lower cervical lymph nodes are as well showing similar CT appearance.
Bilateral multiple innumerable scattered mainly upper lobe centrilobular nodules and tree in bud pattern denoting cellular bronchiolitis.
Upper abdominal cuts showed multiple pathologically enlarged gastro-hepatic, portahepatic, portocaval and retro-crural discrete lymph nodes are seen showing heterogeneous enhancement with areas of low attenuation and calcifications within.
Bulky spleen showing multiple hypodense focal lesions.
Case Discussion
Bilateral upper lobe pulmonary centrilobular nodules with tree-in-bud pattern reflecting cellular bronchiolitis with associated multiple thoracic and abdominal pathological lymph nodes showing peripheral egg shell calcification.
The patient has a history of a relative with active TB staying at her home recently. Tuberculin and serological test were positive for TB and the patient starting receiving anti-tuberculous drugs 6 weeks before the CT exam.
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