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Background <p>Pulmonary tuberculosis and lung cancer are both highly prevalent in Indonesia, often leading to diagnostic dilemmas, as pulmonary tuberculosis can mimic malignant disease radiologically.</p> Case presentation <p>We present a 39-year-old woman initially diagnosed with tuberculous pleurisy based on elevated adenosine deaminase levels and analysis of the pleural effusion. Despite anti-tuberculosis therapy, follow-up imaging revealed growing and suspicious lung nodules with irregular margins, strong enhancement on computed tomography (CT), and a high Fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/CT, suggestive of malignancy. However, histopathological analysis demonstrated granulomatous inflammation consistent with pulmonary tuberculomas. She completed a nine-month anti-tuberculosis regimen with radiological resolution, leaving only fibrotic scarring.</p> Conclusion <p>This case highlights the diagnostic challenge of distinguishing pulmonary tuberculomas and post-pleural tuberculosis sequelae from lung cancer in endemic regions. Retrospective review may clarify the diagnosis, but in clinical practice, physicians must rely on a multimodal approach. Clinical correlation remains essential, as radiology alone cannot stand as the final arbiter.</p>

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Radiology versus reality: a case report of pulmonary tuberculoma following tuberculous pleurisy mimicking malignancy in an endemic country

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月31日

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  • Mira Yuniarti,
  • Allen Widysanto,
  • Ryan Yudistiro,
  • Chelsy Irena Angela,
  • Gilbert Sterling Octavius

摘要

Background

Pulmonary tuberculosis and lung cancer are both highly prevalent in Indonesia, often leading to diagnostic dilemmas, as pulmonary tuberculosis can mimic malignant disease radiologically.

Case presentation

We present a 39-year-old woman initially diagnosed with tuberculous pleurisy based on elevated adenosine deaminase levels and analysis of the pleural effusion. Despite anti-tuberculosis therapy, follow-up imaging revealed growing and suspicious lung nodules with irregular margins, strong enhancement on computed tomography (CT), and a high Fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/CT, suggestive of malignancy. However, histopathological analysis demonstrated granulomatous inflammation consistent with pulmonary tuberculomas. She completed a nine-month anti-tuberculosis regimen with radiological resolution, leaving only fibrotic scarring.

Conclusion

This case highlights the diagnostic challenge of distinguishing pulmonary tuberculomas and post-pleural tuberculosis sequelae from lung cancer in endemic regions. Retrospective review may clarify the diagnosis, but in clinical practice, physicians must rely on a multimodal approach. Clinical correlation remains essential, as radiology alone cannot stand as the final arbiter.