CT features of solitary pulmonary non-caseous tuberculoma: diagnosis and differential diagnosis

doi:10.19871/j.cnki.xfcrbzz.2021.01.008

Abstract

Abstract: Objective To retrospectively analyze the imaging features of solitary pulmonary non-caseous tuberculoma (PNCTB) on CT, and to differentiate from other solitary nodules. Methods The twenty-eight cases of PNCTB, 50 cases of peripheral lung cancer, 16 cases of hamartoma, 18 cases of sclerosing hemangioma, and 33 cases of spherical pneumonia were collected. Two chest radiologists evaluated CT images. The evaluation parameters included lesion size, distribution, satellite lesion, lobulated shape, spiculated sign, vacuole sign and enhancement degree. Results The twenty-eight cases of PNCTB showed no statistical difference with peripheral lung cancer, hamartoma, sclerosing hemangioma, or spherical pneumonia in the lesion size and lobe distribution. There was statistical difference between PNCTB and peripheral lung cancer on the " lobulated shape " and " spiculated sign ", but the pleural indentation sign; only 17.86% of PNCTB had satellite lesions, which had statistical significance compared with spherical pneumonia (90.90%). The satellite lesions of PNCTB showed tree-in-bud sign while spherical pneumonia showed patchy shadow. After contrast-enhanced scan, 64.29% of PNCTB showed heterogeneous enhancement, which was not statistically significant with peripheral lung cancer and spherical pneumonia, but sclerosing hemangioma showed homogeneous enhancement, which could be differentiated from PNCTB. 71.43% of PNCTB had enhancement degree with 16-20 HU, which was statistically significant compared with other nodules in this study. Conclusion PNCTB could be highly suspected when solitary pulmonary nodule with inhomogeneous enhancement and CT value below 20 HU. The possibility of PNCTB diagnosis is greatly increased when satellite focus appears. It is helpful to differentiate solitary nodules from other solitary nodules when there are vacuole sign, cavity, fat, calcification, spiculated sign, lobulated shape, or pleural indentation sign.

Key words: Tuberculosis, Lung, Tomography,X-ray computed, Differential diagnosis

Wei Liangui, Guan Chunshuang, Chen Budong, Lyu Zhibin, Xue Ming, Zhou An, Xu Donghai, Lyu Yan, Xie Ruming. CT features of solitary pulmonary non-caseous tuberculoma: diagnosis and differential diagnosis[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(1): 35-39.

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