Lung mass and tularaemia

Abstract

Learning point for clinicians Radiological signs of pulmonary tularaemia can be indistinguishable from lung cancer, and putatively characteristic CT or even PET/CT images can easily mislead to premature diagnosis of malignancy. Therefore, tularaemia should be considered when unspecific symptoms of pneumonia are present, and the patient has an occupation or hobby at risk. A 41-year-old IT specialist was referred with suspected metastatic lung cancer upon an 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) revealing a high tracer uptake in the enlarged hilar lymph nodes of the right lung, and in several mediastinal and periportal lymph nodes (Figure 1). Two weeks earlier he had consulted his GP with sudden onset of malaise, growing pains, low-grade fever, headache with scintillating scotoma, sore throat and an itching exanthema of the upper part of his body. His otherwise …