Tuberc Respir Dis.  2011 Apr;70(4):347-351.

A Case of Tuberculous Pericardial Abscess Mimicking Thymic Carcinoma

• Park JY
• Park SA
• An YH
• Jang GS
• Kim SY
• An JS
• Hong EY
• Lim SY
• Kim K
• Seo J
• Park S

Abstract

We report here an unusual case of pericardial tuberculoma that was misdiagnosed as thymic carcinoma on an imaging study. A 48-year-old woman was referred for evaluation of an anterior mediastinal mass. Computed tomography (CT) scans of the chest displayed cystic masses mimicking thymic carcinoma at the anterior mediastinum. Pericardiotomy and surgical drainage of the cystic masses were done, and pathologic examination of the excised pericardial specimen showed a chronic granulomatous inflammation with necrosis, compatible with tuberculosis. Acid-fast bacilli were also identified in the specimen. After treatment with anti-tuberculosis drugs and steroids, the patient showed clinical improvement. Although tuberculous pericarditis usually presents as pericardial effusion or constrictive pericarditis, it can also present as a pericardial mass mimicking thymic carcinoma on CT. Therefore, we suggest that tuberculous pericardial abscess should be included in the differential diagnosis of a mediastinal mass in Korea, with intermediate tuberculosis prevalence.

Keyword

Pericardium; Tuberculosis; Thymus Neoplasms; Carcinoma

MeSH Terms

Abscess
Diagnosis, Differential
Drainage
Female
Humans
Inflammation
Korea
Mediastinum
Middle Aged
Necrosis
Pericardial Effusion
Pericardiectomy
Pericarditis, Constrictive
Pericarditis, Tuberculous
Pericardium
Prevalence
Steroids
Thorax
Thymoma
Thymus Neoplasms
Tuberculoma
Tuberculosis
Steroids

Figure

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  Figure 1 (A) Chest PA on admission shows anterior mediastinal widening with left pleural effusion. (B, C) Initial chest CT scans with transverse and coronal images. Chest CT scan displays multi-loculated two cystic masses at the anterior mediastinum (white arrow, 10.5×4.2 cm; black arrow, 6.8×1.7 cm) with peripheral enhancement. No foci of calcification were observed within the mass. PA: Posterior anterior; CT: computed tomography.

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  Figure 2 PET/CT images show FDG uptake in the pericardial lesion with a maximal SUV of 8.3 and central photon defect area. PET: positron emission tomography; CT: computed tomography; FDG: fludeoxyglucose; SUV: standardized uptake value.

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  Figure 3 (A) Pathologic examination of the excised pericardial specimen shows a chronic granulomatous inflammation with necrosis, compatible with tuberculosis (H&E stain, ×100). (B) Acid-fast bacillus was also indentified (black arrow, AFB stain, ×200).

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