Anterior Mediastinal Mass: A Rare Presentation of Tuberculosis

Abstract

We report a case of a 14-year-boy who presented to us with a low-grade fever with evening rise for 9 months. Along with this, the patient also reported a reduction in his appetite and body weight. He had a mild dry cough but no respiratory symptoms otherwise. There was no other localization for fever on history. He received antitubercular therapy, based on abnormal chest radiograph. However, there was no relief in his symptoms. General physical examination revealed mild fever. Systemic examination was unremarkable. Blood investigations done for fever were noncontributory. Computed tomographic (CT) scan of the chest revealed a mediastinal mass compressing the trachea. The possibilities of lymphoma or germ cell tumour were considered. A biopsy from the mass under CT guidance was performed. The histopathology revealed multiple epithelioid cell granulomas with necrosis, and the diagnosis of tuberculosis was made. The clinical course of this patient and the relevant literature is presented in this paper.

A Study of Clinical Characteristics of Mediastinal Mass

“…All were started on anti-tubercular treatment and showed good clinical improvement; though radiological resolution was seen in three patients among them. Isolated involvement of the mediastinum by tuberculosis is very rare in adults [16]. There have been very few case reports of adult mediastinal tuberculosis in the literature [17,18].…”

Tuberculous mediastinal lymphadenopathy in an adult

“…TB, sarcoidosis, lymphoma, histoplasmosis and neoplasia are the common causes of mediastinal lymphadenopathy. It may be very difficult to differentiate radiologically one from the other 2. CT chest usually reveals right-sided adenopathy, and specifically, right paratracheal lymph node enlargement in tuberculosis.…”

“…The diagnostic value of sputum examination is low in patients without parenchymal lesions of tuberculosis, most of whom require procedures such as bronchoscopy, CT-guided fine-needle aspiration biopsy or mediastinoscopy to establish a definite diagnosis 2 4. In a study by Ayed AK and Behbehani NA, the incidence of intrathoracic tuberculous lymphadenitis was 2% of 1700 new cases of tuberculosis over a 4-year period.…”

A rare cause of mediastinal mass: tuberculosis

“…In literature 11 cases of isolated mediastinal mass were reported [3][4][5][6][7][8][9][10][11][12][13]. In four cases, mediastinal mass was excised with thoracotomy.…”