J Korean Soc Radiol.  2015 Mar;72(3):202-205. 10.3348/jksr.2015.72.3.202.

A Large Tuberculous Abscess Mimicking a Retroperitoneal Cystic Mass: A Case Report

• Kim KS
• Cha S
• Ahn J
• Cho M

• KMID: 2161175
• DOI: http://doi.org/10.3348/jksr.2015.72.3.202

Abstract

Large cystic masses originating from the retroperitoneal space are rare, and cystic tumors are often considered preferentially in the differential diagnosis. However, it is difficult to make a correct diagnosis. A 55-year-old man presented with a palpable abdominal mass. A computed tomography (CT) scan detected a mass mimicking a large cystic tumor in the retroperitoneal space anterior to the psoas muscle. The mass had an enhanced outer margin, an irregular inner margin, and several surrounding necrotic lymph nodes. However, histopathologic examination followed by an exploratory laparotomy confirmed that the mass was consistent with a tuberculous (TB) abscess. A retroperitoneal TB abscess without spinal or active pulmonary TB is very rare. To the best of our knowledge, there are no published reports of a retroperitoneal TB abscess confirmed by both CT scan and surgical pathology in the Korean literature. We report a rare case of a huge retroperitoneal TB abscess that can mimic a cystic tumor.

MeSH Terms

Abscess*
Diagnosis
Diagnosis, Differential
Humans
Laparotomy
Lymph Nodes
Middle Aged
Pathology, Surgical
Psoas Muscles
Retroperitoneal Space
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Oval-shaped cystic mass in the right lower retroperitoneal space. A. Precontrast axial image shows a large retroperitoneal mass (white arrowheads) compressing the psoas muscle (asterisk). B. Postcontrast axial image shows that the cystic mass has a well-defined outer margin, an irregular inner margin, and wall enhancement (white arrowheads). C. Coronal image shows focal calcifications (black arrowhead) within the mass. D. Multiple lymph nodes with necrotic changes (white arrowheads) are observed around the large mass (asterisk). E. Gross specimen of the excised mass. F. Histological examination shows granulomatous inflammation with central caseous necrosis consistent with tuberculosis (hematoxylin and eosin stain, × 200).

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