PSEUDOTUMORAL PULMONARY TB MASS: WHAT IS THE PLACE OF SURGERY FOR DIAGNOSIS?

Abstract

TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: The pseudotumoral form of pulmonary tuberculosis (PTPT) is extremely rare. It constitutes a diagnosis dilemma by simulating pulmonary cancer. Surgical investigation is required when non-invasive modalities of diagnostic don’t identify the PTPT. METHODS: Sixteen immunocompetent patients presenting a PTPT, were operated in the Thoracic and Cardiovascular Surgery Department of Ariana in Tunisia between 1997 and 2020. RESULTS: They were 14 men and 2 women. The average age was 53 years. Two patients had a history of treated pulmonary tuberculosis. Eleven patients were smokers. The median overall diagnostic delay was 6 months. Productive cough (n=4) and chest pain (n=4) were the major symptoms. The chest X-ray revealed a dishomogeneous opacity with an irregular outline in 75% of cases. The computed tomography of chest showed a tissue mass mimickig malignancy in 10 cases and a suspicious parenchymal condensation in 2 cases. The most common site involved is the upper right lobe (10 cases). Cavitation was seen in 3 cases. The bronchoscopy showed a stenosing bronchial wall infiltration in 5 cases. All bronchial biopsies were inconclusive. Sputum and bronchoalveolar fluid acid fast bacilli smear and culture were negative. Through a posterolateral thoracotomy, we performed a lobectomy (n=12), wedge resection (n=2) and tumor biopsy (n=2). Histological exam concluded to pulmonary tuberculosis. All patients received anti-bacillary therapy with good clinico-radiological evolution. CONCLUSIONS: The positive diagnosis of PTPT is difficult. Surgery remains the reliable means of diagnosis for initiating early medical management. CLINICAL IMPLICATIONS: Diagnosis of PTPT can be delayed and lead to surgical resection DISCLOSURE: Nothing to declare. KEYWORD: pseudotumoral, lung, tuberculosis, surgery