Tuberculosis (TB) is well known as a diagnostic chameleon and can resemble malignancy. In thorax TB can be manifested as pulmonary infiltrates and/or mediastinal lymphadenopathy. In low incident countries with high incidence of lung cancer and varying clinical presentations, TB often gets misdiagnosed with the result of delayed treatment start and unnecessary diagnostic procedures.Our case report presents two patients, who were referred to the Thorax diagnostic centre at the Department of Respiratory Medicine, Odense University Hospital, with presumptive diagnosis of neoplasm and had proved lung TB with no evidence of malignancy instead. In the first case diagnosis was confirmed after thoracotomy, in the second case after bronchoscopy.

BackgroundThe purpose of the current study was to clarify the sensitivity and complication rate of the radial (endobronchial ultrasound, EBUS) without the use of guide-sheath (GS) and fluoroscopy for lung cancer (LC), by measuring the distance from the orifice of the bronchus to the pulmonary lesion, as well as to analyze factors that can predict the diagnostic outcome.Materials and methodsA total of 147 patients with peripheral pulmonary lesions (PPL) underwent radial EBUS-guided transbronchial biopsy (TBB) in between August 1, 2013, and August 31, 2014. We analyzed retrospectively radiological data, diagnostic work-up in everyday clinical settings, final diagnosis and complication rates, as well as factors influencing the diagnostic outcome.ResultsAround 63.9% of PPLs were visualized by ultrasound. A definitive malignant diagnosis was established in 39 patients (26.5%) using radial EBUS. In the remaining 108 patients, additional procedures were performed. We missed LC diagnosis in 40 cases that results in a sensitivity of 49%. For malignant lesions visualized by radial EBUS, the sensitivity was 60%, compared with 24% for not visualized lesions. For malignant lesions, logistic regression was performed to identify the factors that had significant influence on visualization of the lesion and on diagnostic yield. Logistic regression analysis showed significant odds ratios (OR) for visualization depending on location of the lesion; upper lobe lesions were identified more frequent with OR of 3.85 (95% CI 1.42 – 10.98, p=0.009). Size above 30 mm had a non-significant OR of 2.11 (95% CI 0.80−5.73, p=0.134) for visualization.Diagnostic yield was only significantly influenced by visualization with the radial EBUS, OR 3.70 (95% CI 1.35−11.02, p=0.014). Location (p=0.745) and size above 30 mm (p=0.308) showed no significant increase in diagnostic yield.Other lesion characteristics defined on computed tomography, such as distance to carina and pleura, did not show any significant influence on the diagnostic yield. The complications rate was low with three cases of pneumothorax.ConclusionRadial EBUS has definitely its place in the diagnostic work-up of PPL, especially for the lesions that can be visualized by radial ultrasound. However, prospective randomized controlled studies are necessary to raise the diagnostic yield and to define factors that can predict the outcome, which will consequently enable selection of the ‘right’ patients for this diagnostic procedure.

A 16-year-old girl presented with intermittent left chest pain and breathlessness on exertion for last 4 months with one episode of haemoptysis. There has been loss of appetite and weight loss of 4 kg over a period of 1 month. A chest radiograph revealed a large mass like opacity with pleural effusion in the left lung field. Computerized Tomography scanning (CT scanning) and Positron Emission Tomography/Computerized Tomography scanning (PET/CT scanning) demonstrated a 7 cm round, cystic lesion in the anterior mediastinum. Pleural fluid cytology did not show any malignant cell. The patient was referred to cardiothoracic department for thoracotomy and resection. Surgery was uncomplicated with rapid recovery. Histologic findings suggested mature teratoma components surrounded by oedematous pleura and pericardium with adjacent thymus and lung tissue.

We present a case of systemic sarcoidosis involving the liver, pancreas, lungs, mediastinal and intraabdominal lymph nodes and bones. Multiple organ system manifestations mimicked malignant metastatic disease. The diagnosis was established with clinical, radiological, and pathological findings after neoplasm was ruled out by pathological tests. The patient showed rapid symptom remission with systemic steroid treatment.

We report a case of a 46-year-old woman without any medical history who presented to our Respiratory Department with exertional dyspnoea for the last 6 weeks associated with non-productive cough. Chest radiography showed bilateral diffuse interstitial opacity. Bronchoalveolar lavage and transbronchial biopsies performed during flexible bronchoscopy as a step in the diagnostic workup of idiopathic interstitial pneumonia showed cells of pulmonary adenocarcinoma.